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 Elaine Wexler-Mitchell, D.V.M.
This book is printed on acid-free paper. ∞
Copyright © 2004 by Elaine Wexler-Mitchell. All rights reserved.
Howell Book House
Published by Wiley Publishing, Inc., Hoboken, New Jersey
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Library of Congress Cataloging-in-Publication Data:
Wexler-Mitchell, Elaine.
  Guide to a healthy cat / Elaine Wexler-Mitchell.
     p. cm.
  ISBN 0-7645-4163-3 (alk. paper)
 1. Cats. 2. Cats—Health. I.Title.
  SF442.W455 2003
Printed in the United States of America
10 9 8 7 6 5 4 3 2 1
All photos by Elaine Wexler-Mitchell

Preface, ix

Chapter 1     What Is a Healthy Cat?, 1
              Characteristics of a Healthy Cat, 1 • The Lowdown on Essential
              Care, 2 • The Scoop on Litter Boxes, 4 • Keeping Cats
              Indoors Keeps Them Healthier, 7

Chapter 2     Kitten Development, 9
              Birth to 1 Month, 10 • 4 to 6 Weeks, 11 • 6 to 8 Weeks, 12
              • 8 to 16 Weeks, 12 • 16 to 28 Weeks, 13 • Puberty, 13 •
              6 Months to 1 Year, 15

Chapter 3     Feline Mental Health, 16
              Keys to Good Feline Mental Health, 17 • Signs of Stress, 18   •
              Proper Handling Keeps a Cat Happy, 19 • Adding a New
              Cat, 21 • Kitty’s Being Mean!, 23 • Housesoiling, 24 •
              Turn It Down!, 26

Chapter 4     Good Grooming, 27
              Start With the Claws, 28 • Should You Comb or Should You
              Brush?, 29 • What About a Longhaired Cat?, 31 • Mats and
              Their Problems, 32 • Bath Time, 34 • Give Up?, 35

vi Contents

Chapter 5     The Best Nutrition for Your Cat, 38
              Picking the Right Food, 39 • Essential Differences in Cats, 41
              • Viva Variety, 42 • Feeding by Life Stage, 43 • Drink It
              Up, 44

Chapter 6     How Do I Know if My Cat Is Sick?, 46
              Is Your Feline Anorexic?, 47 • Does Your Cat Have a
              Fever?, 49 • What to Do When Your Cat Is Acting Funny, 51
              • Typical Signs of Illness, 52 • When to Go to the Emergency
              Room, 53 • Checking Out Your Medicine Cabinet, 54 •
              A Spoonful of Sugar Helps the Medicine Go Down, 57

Chapter 7     How to Choose a Veterinarian, 62
              Selection Basics, 62 • Feeling Comfortable, 65

Chapter 8     Annual Health Care, 71
              Did Your Cat Pass His Physical?, 71 • Viral Testing, 73 •
              What About Vaccines?, 74 • A Cheshire Cat Smile, 74 •
              Parasite Control, 77

Chapter 9     Tell Me About Vaccines, 81
              How Do Vaccines Work?, 81 • What You Should Know About
              Vaccinating Your Cat, 83 • Core Vaccines, 85 • Non-Core
              Vaccines, 87 • Kitty Needs Shots, 91 • Adverse Responses to
              Vaccines, 92

Chapter 10    Common Surgical Procedures, 94
              Tell Me About Declawing, 94 • Prevent a Paternity Suit, 97   •
              Prevent Unwanted Pregnancy, 99 • Hernias in Cats, 101

Chapter 11    Pregnancy and Queening, 103
              The Estrous Cycle, 103 • The Act, 104 • When Your Cat Is
              Pregnant, 105 • The Birth of Kittens, 108 • Raising an
              Orphan, 110

Chapter 12    How to Care for a Senior Cat, 112
              How Long Will My Cat Live?, 112 • Senior Health Care
              Program, 113 • What May Cause Your Kitty’s Demise?, 114
              • Keeping Your Old Friend Comfortable, 120 • Knowing When
              to Let Go, 123
                                                               Contents vii

Chapter 13   The Respiratory System, 125
             Sneezing, 126 • Cats Do Catch Colds, 127     •   Could Your Cat
             Have Asthma?, 131 • Pneumonia, 133

Chapter 14   The Gastrointestinal System, 135
             It All Starts in the Mouth, 135 • Kitty’s Going to Be Sick, 137
             • Getting to the Box, 140 • Inflammatory Bowel Disease
             (IBD), 142 • What Is Helicobacter?, 143 • Intestinal
             Cancer, 143 • When Kitty Is Constipated, 143 • Is Your Cat
             Turning Yellow?, 145 • Pancreatitis, 147 • The End of the
             Line—Anal Gland Problems, 148

Chapter 15   Skin and Dermatology, 149
             Itchy Kitty, 149 • Kitty Is Bald!, 153 • Zitty Kitty, 153
             • Ringworm Is Not a Worm, 154 • Looking Mitey Mangy,
             156 • Insect and Spider Bites, 158 • Other Ear Problems, 158
             • Cats Can Get Skin Cancer, 159 • Infections and Abscesses, 160
Chapter 16   The Cardiovascular System, 161
             How the Heart and the Circulatory System Work, 161 • Blood
             and Bleeding, 162 • If Your Cat Is Anemic, 164 • Born With
             a Bad Heart, 166 • Leaky Valves, 166 • How the Heart
             Is Evaluated, 167 • Treating Congenital Heart Disease, 168
             • Heart Muscle Disease, 168 • High Blood Pressure, 169 •
             Feline Heartworm Disease, 170

Chapter 17   The Musculoskeletal System, 172
             It’s Hard to Get Up in the Morning, 173 • It’s Broken, 176
             • Sprains and Strains, 177 • Do Cats Get Cruciate
             Injuries?, 178 • Born With Unique Bones, 178 • Surgery
             for Bone Deformities, 180

Chapter 18   The Endocrine System, 181
             If Your Cat Has a Hyper Thyroid, 181 • Feline Diabetes, 185
             • Uterine Infections, 187 • Cats Can Get Breast Cancer, 188
             • Adrenal Gland Disease, 189
Chapter 19   The Nervous System and the Senses, 190
             The Eyes See You, 191 • The Ears Hear You, 194
             • Kitties and Convulsions, 195 • Born With Neurologic
             Problems, 197 • Cats With Bad Backs, 198 • Feline
             Hyperesthesia Syndrome, 200
viii   Contents

Chapter 20        The Urinary Tract, 201
                  Lower Urinary Tract Disease, 202 • Kitty Can’t Pee!, 204
                  • Stones in the System, 206 • What About Diet?, 208 •
                  Kitty’s Kidneys, 209

Chapter 21        The Dreaded Viruses, 214
                  Feline Leukemia Virus, 214 • Feline Immunodeficiency
                  Virus, 216 • Feline Infectious Peritonitis, 218 • Could Your
                  Cat Be Rabid?, 222 • Feline Panleukopenia, 223

Chapter 22        Understanding Diagnostic Testing, 224
                  Fecal Analysis, 224 • Urinalysis, 225 • Blood Tests, 226
                  • X Rays, 229 • Ultrasound, 230 • Endoscopy, 230 •
                  Biopsies, 230 • Cytology, 231 • Electrocardiogram, 231
                  • Blood Pressure, 232 • Cerebral Spinal Fluid Tap, 232
                  • Magnetic Resonance Imaging, 232 • Computed
                  Tomography, 233 • Nuclear Imaging, 233 • Technological
                  Advances Are Amazing!, 233

Chapter 23        What Can Your Catch From Your Cat?, 234
                  Gesundheit!, 235 • Honey, It’s Your Turn to Scoop, 237
                  • Cat Scratch Fever, 240 • Other Zoonoses, 241 • Watch
                  Out for Plague, 242 • The Joys of Cat Ownership, 243

Appendix A        Glossary of Veterinary and Cat Terms, 245

Appendix B        Where to Learn More, 251

Appendix C        Pet Loss Grief Counseling Hot Lines, 253

About the Author, 256

Index, 257

People often ask me why I became a feline-only veterinarian after I
started out working on both dogs and cats. I loved working with cats,
but had seen how they were often regarded as second-class citizens in
comparison to dogs in the veterinary world. I considered my options
and I decided to start my own clinic and go feline only so I could focus
my time and energy on becoming the best doctor I could possibly be
in the practice of feline medicine.
     In this book I hope to share my knowledge of cats and their health
care with you. Each cat has an individual personality and touches us
uniquely. Anyone who has owned a cat knows about their special
charm as well as their idiosyncrasies. Are these not the aspects that cap-
tivate us as cat owners?
     I think that people who do not like cats have, unfortunately, missed
out on the experience of these furry creatures. Every day that I spend
with cats, I learn something new about how they view the world and I
am fascinated by it. By understanding your cat and her health care
needs, you will have the tools to enable you to be a fabulous cat
owner—that is, if you actually believe you own your cat!

Chapter 1

What Is a Healthy Cat?

More than 73 million pet cats live in households in the United States.
What is it about these creatures that has made them America’s most
popular pet in the last decade? Is it their grace and beauty? Or is it their
ability to be somewhat independent and fit into our busy lifestyles?
Regardless of the reasons, it is definitely cool to be a cat owner.
    You have also decided to become a cat owner—or at least, you’d
like to think it was your decision. In reality, it is often the cat who
chooses you. Each cat has a unique personality and different behavior
patterns, so I hope you will find the perfect fit for your household.

Bright eyes, a shiny coat and an alert disposition are all characteristics
of a healthy cat. Healthy cats have good appetites, groom themselves
well and interact with their owners.There is no one best place to find
a healthy cat, so in your search consider local shelters, breeders, neigh-
bors, friends, coworkers and veterinary clinics and hospitals.
     The most important factor in choosing a healthy cat is a good per-
sonality.You can tell a lot about personality even with kittens.To test a
cat’s personality, hold her in your arms and see if she is relaxed or tense.
2   Guide to a Healthy Cat

Cradle her upside down in your arms, like a baby, and again, see how
she reacts. If you are looking for an affectionate cat, and the one you are
testing will not let you hold her for more than a second, you may want
to reconsider your choice or plan to do some work on gaining the cat’s
trust and training her to relax.
     Two to seven weeks of age is the period considered to be critical to
a kitten’s socialization. Kittens who are handled by many people and
interact with other cats and animals during this time tend to adjust bet-
ter socially as adults. Ask about a cat’s early experiences when you are
considering her for adoption.
     The next test is to touch the animal’s ears, gently open her mouth
and touch her toes. Again, the more the cat is willing to let you handle
her, the more likely she is to be trusting of you in general. If you put
the cat down and walk away, is she interested in you? Does she follow
you? I do think there is chemistry between certain cats and certain
people. Is the cat alert, responsive and playful? Test this by throwing a
small toy, or even make one from a ball of paper.All these little tests will
give you some idea of what the cat’s personality is like.
     Even with a very healthy kitten, the health care costs for a kitten for
the first year are generally higher than they are for an adult cat. Kittens
have less well-developed immune systems than adult cats, so they are
more susceptible to infections. They also require more routine health
care during their first year of life than older cats do. This includes ini-
tial vaccines, viral and fecal testing and spaying or neutering.

Now that you have your cat and have brought her into your home, you
need to make sure you adequately provide for her essential needs. In the
wild, cats adapt to their environment by hunting for food, seeking safe-
ty by climbing trees and finding shelter against the elements. Confined
to our homes, cats need help to live harmoniously in our environment.
    If you provide the basics of good food, water and shelter, you will
be starting your cat off right. Monitoring the ways in which the cat uses
these basic provisions will give you a good idea about the animal’s
health. Cats are creatures of habit, so any changes in their habits war-
rant investigation.
    Privacy is very important to your cat. Even the most sociable cat
needs some time alone. Cats typically like privacy when they groom
and when they eliminate. Some cats like privacy when they eat, but
others eat more readily when their owners are around.
                                                               What Is a Healthy Cat? 3

     Cats with more timid personalities should be allowed to hide for at
least some part of the day.You can work to make your cat more social,
but many felines are scaredy cats by nature and no amount of training
will change this trait. People often tell me they think their scaredy cat
was abused before they found her, but it is more likely the cat was born
that way. Timid cats will learn to trust you and can become incredibly
loving companions, but they are not likely to ever warm up to strangers.
     Cats who have to acclimate to new cats, dogs or children in a
household should be given time alone. It is not fair to expect the exist-
ing animal to be happy about and willing to accept newcomers.This is
just not the nature of cats. Cats hate change.They prefer things to stay
the way they are—the way they arranged them! It can take weeks to
months for a new cat to accept her new surroundings, or at least to be
less fearful.
     When a new cat or kitten is brought into a household with children,
everyone is excited and everyone wants to hold and play with the
animal. Being the constant center of attention is not typically what a cat
wants. Parents need to control the handling of the cat and be sure the
animal is given an opportunity to rest by herself.

Even the biggest scaredy cat will learn to trust and love you, although she may never warm up
to strangers.
4   Guide to a Healthy Cat

    Entering a new home is stressful to a cat, and not getting a chance
to regroup and relax merely intensifies the stress. Stress has a negative
impact on the animal’s immune system, so be sure to give the cat a
break and help keep her healthy. Make sure the cat has a hiding place
where she can go to relax, and make it a rule in your house that when
the cat is in her hiding place, she is to be left alone. If you cannot iso-
late a cat in a quiet room for a break, you might consider placing her
back in her carrier for a while.The carrier can offer safety and solitude.

Proper placement of the litter box in your home is essential if you want
the cat to use it. Ideally, the cat should feel comfortable, safe and undis-
turbed when she eliminates. Often, elimination problems arise when a
cat is unhappy about the location of her box.Areas where you want the
box and where the cat wants the box may not be the same.You will
have to give in to your cat’s preferences.
     Bedrooms, secondary bathrooms and garages are good locations for
litter boxes. Many owners want to put litter boxes in laundry rooms.
This can work for some cats, but others may be frightened by the nois-
es of the washer and dryer and may choose to eliminate elsewhere.
     Starting off on the right track with a good litter box setup will
make both you and your cat happy. Litter boxes are available in a vari-
ety of sizes and shapes.Your cat will probably be more concerned with
the type of litter in the box than she will with the type of box you
choose—but some cats can be very picky about the box, too.
     There are two main types of litter boxes: open and hooded. Litter
boxes are generally made of plastic. Almost all cats are satisfied with an
open litter box, but each type has its pros and cons, as outlined in the
table on page 5.
     In this high-tech era, there are also electronic litter boxes.These are
the most expensive types of litter boxes, but they offer convenience
because they do not require daily maintenance.
     One type, called Litter Maid, is an open box that contains an elec-
tronic sensor that detects the cat’s presence, automatically rakes the lit-
ter after the cat has left the box and deposits the waste materials into a
closed plastic receptacle. Owners must dispose of the full receptacles
every few days.The box is filled with clumping litter, and both the box
and rake need to be cleaned regularly.
                                                      What Is a Healthy Cat? 5

                                 OPEN LITTER BOX
 Pros                                     Cons
 Easy for the cat to get in and out       Less odor control
 Easier for you to scoop                  More litter scatter
 Takes up less space                      Cats can eliminate over the sides
 Some cats (especially large ones)        Accessible to dogs and babies
   feel cramped in a hooded box           Some cats prefer more privacy

                              HOODED LITTER BOX
 Pros                                     Cons
 More odor control                        May be harder for cat to get in
 Less litter scatter                       and out
 Prevents access for dogs and babies      Less convenient for you to scoop
 Helps contain urine and feces            Requires more space
 Some cats prefer more privacy            Some cats (especially large ones)
                                            feel cramped

    Another type of electronic box that washes, dries and disinfects
plastic litter has been invented.This type of cat toilet, which eliminates
any routine maintenance by the owner, is likely to be the litter box of
the future.
    The height of the sides of the box can vary, and that’s another thing
you need to consider. Kittens and senior cats may have difficulty jump-
ing into boxes with high sides. The same may be true for injured
    Be sure to get a litter box that is big enough to accommodate your
cat.The cat should be able to turn around and easily scratch and cover
up wastes in her box.You may need to buy a larger litter box as your
cat grows.
    A cat should have unrestricted access to her litter box. Putting it in
a room where the door may be accidentally closed or in a garage with-
out a pet door (or where it gets so cold that she is unlikely to go there)
will create problems. The location of the box in the house will also
encourage or discourage use. Of course you want to put the litter box
in the area that is most convenient for you, but your cat’s needs and
wishes should be considered first.
6   Guide to a Healthy Cat

     A good general rule is to have at least the same number of litter
boxes as you do cats in a household. This can pose problems in large,
multicat homes. One reason for multiple boxes is to spread out smell
and wastes so that they do not become too concentrated too quickly
and deter a cat from using the box. Even if you have many boxes, not
all cats will use all boxes. But it’s still important to have them, because
some cats simply will not go where other cats have gone.
     Today kitty litter is available in numerous varieties. Some are envi-
ronmentally friendly and some are easier to clean up. Litters are made
from a number of different materials, including clay, pine shavings and
pelleted newspaper.You need to determine which factors are important
to you when choosing litter and then hope your cat feels the same way.
Factors for you to consider are cost, presence of deodorizers, size of
packaging, ease of scooping, ease of disposal, biodegradability and litter
tracking outside of the box. The factors your cat will consider are size
and softness of granules, scent (cats prefer no scent) and cleanliness.
When given a choice, most cats prefer clumping litter. The benefits of
clumping litter are that urine and feces can be easily removed from the
box every day. The texture is similar to outdoor sand or dirt, which is
what cats are naturally attracted to. If your cat has a urinary tract prob-
lem and you are trying to monitor the amount and the frequency of
urination, clumps are easy to evaluate.There is no scientific evidence to
prove that clumping litters specifically create any health problems in
cats. However, clay, clumping and other litters that produce dust have
been shown to increase irritation in the airways of cats affected by res-
piratory diseases.
     Cats like to have a minimum of one inch of litter in their boxes, and
most like even more. If the litter level drops and you are not ready to
empty the box (for example, if you use clumping litter), simply add
more litter.
     Litter boxes should be scooped at least once a day. More often is
even better. Depending on the type of litter used, the box should be
completely emptied, cleaned and refilled every one to two weeks.
We like using clean bathrooms, and so do our cats. Plastic liners are
frequently used to help make box emptying and cleaning easier, but
some cats do not like liners. Again, you’ll have to follow your cat’s
     Empty boxes should be washed with soap and water or white vine-
gar and water. Products containing ammonia should not be used to
                                                   What Is a Healthy Cat? 7

clean litter boxes because urine contains ammonia and cleaning that
way will simply intensify the odor.

Housing cats exclusively indoors is the best way to keep them safe.The
average expected life span of an indoor cat is 13 to 15 years, while out-
door cats may live only five to seven years. Unfortunately, cats are fas-
cinated by the outdoors and some try to sneak out at any opportunity.
Some cats like to just bathe outdoors in the sun; others like to hunt and
visit neighbors. Once a cat has had a taste of living outdoors, it is hard-
er to keep her inside, but it is possible if you are determined.
     Giving cats inside window perches and plenty of interactive play-
times will help keep them stimulated and eliminate the need for them
to go outside. If you want to let a cat out, but at the same time protect
her, you can build an outdoor enclosure that is securely screened to
keep her in and to keep danger out.You might also consider training
her to walk on a leash or personally supervising her outdoors for short
periods of time.
     Dangers cats face when they venture outdoors include cars, wild
animals, territorial cats, unfamiliar dogs, unkind neighbors, bad weath-
er, fleas and ticks, more risk of exposure to toxins and disease and get-
ting lost. Where I practice in Southern California, the most common
cause of death to outdoor cats is coyote attacks. If you are prepared to

                              SAFE TRAVEL

    Cats should always be transported inside a carrier when you travel
    anywhere with them. Although the cat may cry and scratch in the
    carrier, it is for her own good as well as yours.You may feel like
    you have good control of the cat when you are carrying her, but if
    she’s startled, her claws digging into your arms may cause you to
    release her.There is also danger if you are driving in your car and
    the cat is not in a carrier. If you slam on the brakes and the cat
    goes flying, she could end up under your feet or be injured. She
    might also decide to walk in front of your face or under the brake
    pedal while you are driving.
8   Guide to a Healthy Cat

take these risks with your cat, then let her go outside. If you are not,
then protect your cat by keeping her inside.
    If you allow your cat any access at all to the outdoors, it is impor-
tant to get the cat on a routine where she comes inside from dusk to
dawn to limit her exposure to the increased dangers of the night. It is
also crucial to place some kind of identification on her such as a collar,
tag, microchip, ear tag, tattoo or a combination of these. Nationwide,
only 2 percent of the cats picked up by animal control agencies are ever
reclaimed by their owners.Without identification these cats are consid-
ered strays. Unfortunately, most unclaimed cats face death. If you are
concerned about the safety of a collar, breakaway styles are available and
work well.
Chapter 2

Kitten Development

Kittens develop very quickly and are grown-up cats before you know it.
The maturation that occurs during a kitten’s first six months of life cor-
relates to the first 15 years of a human’s life. From birth to six months, a
kitten changes from a newborn to a sexually mature animal. In the past,
when I got a new kitten, all I wanted to do was stay home with him all
the time. My husband thought I was crazy, but I told him the kitten
would be all grown up within a few months and I didn’t want to miss
his kittenhood. I guess that’s what people say about their own children
growing up, so it is a natural feeling for all kinds of parents!
     Kittens seem to work at two speeds: full power and full stop. They
seem to have unending energy, and then they crash and sleep very
soundly. Starting off with a new kitten is a lot of fun, but if you are a
first-time cat owner, you may have questions about what normal
behavior is. Knowing what to expect with regard to kitten development
is helpful so you can work on training your kitten properly and be able
to intervene if behaviors get out of hand.You have the best chance of
molding your kitten into the perfect pet when he is young.

10 Guide to a Healthy Cat

During this period a kitten develops from being totally dependent on
his mother for food, warmth and elimination, to being able to handle
these things on his own. Newborn kittens can neither see nor hear, but
they can smell, and they have touch receptors on their faces that enable
them to home in on their mother’s body heat.
    If you find a newborn orphaned kitten, you will have to perform
the duties that the mother cat would have performed. These duties
include keeping him warm and safe, feeding him with proper cat milk
replacer through a bottle and “pottying” the kitten. Kittens are unable
to eliminate on their own until they are about four weeks old, and their
mothers stimulate them to eliminate by licking their genitalia.You can
replicate this action using a cotton ball or tissue soaked in warm water
and gently wiping the kitten’s genitalia.
    Make sure you use a feline milk replacer, and not any other kind of
milk.Although they love the taste of cow’s milk, cats are fairly lactose intol-
erant.They lack the enzyme needed to properly digest the sugar found in
cow’s milk, so more than a taste or two will usually cause diarrhea.
    The mouth is a very important organ for a kitten. A newborn kit-
ten will start using his mouth within an hour of birth, when he starts
nursing. Kittens nurse every few hours around the clock for the first
couple of weeks of life.
    Kittens’ ears open around five days of age.They can orient to sounds
at about 10 days, but they don’t recognize sounds until they are three
weeks old. Eyes open between 5 and 14 days after birth, but kittens can-
not visually orient until their eyes have been open a few days.
    Newborn kittens can feel with both their front and rear limbs.They
can walk with uncoordinated motions at two weeks and can visually
place their front legs and climb by three weeks.
    Immunity is passed to newborns when they receive colostrum, their
mother’s first milk, during their first 24 hours of life.They are protect-
ed from most diseases during their first month if they ingest colostrum,
continue to nurse normally and are kept warm and clean by their
                                                    Kitten Development   11

These newborn kittens are only minutes old.

Most kittens begin to eat some solid food at four weeks of age and can
be fully weaned by six weeks. It is normal for kittens to eat dirt or kitty
litter during the weaning process, but they learn quickly that these sub-
stances don’t taste very good. Kittens have all of their baby teeth by six
weeks of age. Kittens who go outdoors and are trained by their moth-
ers can learn some rudimentary hunting behavior during this time.
     This is a very important period in the socialization process. Kittens
who are not exposed to humans and other animals (including other
cats) at this stage can have a harder time adjusting to them later on in
life. Coordinated social play behavior develops during this time.
     The kittens’ eyes change from blue to their permanent color, they
regulate their own body temperature and start to control their urina-
tion and defecation during this time. Protection against disease is still
mainly conferred through maternal immunity—the antibodies derived
from their mothers.
12 Guide to a Healthy Cat

These three little kittens are seven-week-old littermates.

This is the earliest time for a kitten to be taken from his mother and
littermates and introduced into a new home—although it’s best wait
until they are at least eight weeks old.A kitten of this age should be able
to care for his own basic needs. In a new home, a kitten may be scared
and lonely at first, but he should be able to adapt.
     Maternal immunity wanes, and kittens need to begin their vaccina-
tion series to stimulate further protection against certain diseases.
Natural exposure to viruses and bacteria causes disease, but it also stim-
ulates antibody production and increases future immunity.
     Kittens need the increased protein, vitamin and mineral content of
specially formulated kitten foods to support their growth and develop-
ment.They are able to consume both dry and canned kitten foods.

During this period kittens adjust to their independence and become
stronger and more curious. They grow rapidly and usually gain about
one pound per month.They begin to jump, climb and scratch. Owners
                                                    Kitten Development   13

can make a big impact on their kitten’s behavior by training him dur-
ing this time.
    Vaccinations and natural exposure continue to contribute to the
kitten’s immune system. If not vaccinated, kittens are very susceptible to
viruses such as panleukopenia and feline leukemia if they are exposed
to other cats who have these diseases.The need for a special kitten diet
also continues, and the kitten will be eating more and more.

16 TO 28 WEEKS
From four to seven months of age a kitten loses his baby teeth and gets
his permanent adult teeth. Biting and chewing behaviors increase.
During this period it is common for kittens to chew on everything in
sight, including your hands and feet. They are able to continue eating
both dry and canned kitten foods.
    The animal’s coat fills out and there is more interest in grooming
and scratching behaviors. Most kittens do not reach behavioral sexual
maturity until after six months of age, but they can be physically mature
before then. Kittens allowed outside at this age will roam farther and
for longer periods of time.

Cats go through physical maturation before they are behaviorally
ready to reproduce. The time of year has an effect on reproduction,
as cats are seasonally polyestrus (during certain seasons of the year,
cats can go through their heat cycles multiple times). Veterinarians
recommend that cats be spayed or neutered before they begin to
exhibit sexual behaviors for many reasons. Some of the important
reasons are:

     • Neutered cats tend to be calmer and more easygoing.
     • Neutered cats stay closer to home (and are more comfortable
       being indoor-only cats).
     • Neutered cats fight less and are less protective of their territory.
     • The cycling of sex hormones can trigger some health
       problems in cats.
     • The odor of sexually mature male cats is unbearable.
14 Guide to a Healthy Cat

Male “Coming of Age”
Male kittens start producing low levels of testosterone at about three
and a half months of age. They can produce sperm by five months of
age, but they are not usually able to copulate before they are 9 to 12
months old. Some behaviors you may see as a kitten begins sexual mat-
uration are gripping the neck of another cat from behind, pelvic thrust-
ing and mounting.
    Most male cats have two testicles descended into their scrotums at
birth. If the testicles have not reached the scrotum by eight months of
age, it is unlikely they ever will. If a testicle is retained (called monorchid
if one testicle is retained and cryptorchid if both are), it should be
removed when the animal is neutered to prevent the possible develop-
ment of tumors.The surgical procedure used with a cryptorchid cat, if
the testicle is in the abdominal cavity, is similar to that used when spay-
ing a female cat.

Female “Coming of Age”
Once a female cat begins to have her estrus cycle, she is able to con-
ceive. The estrous cycle is the hormonal cycle that defines female
“heat.” Cats do not bleed when they are in heat, and the signs of heat
in a female cat are all behavioral (see the list below). Most indoor cats
will begin to cycle at five to nine months of age.
    The kitten’s environment plays a role in what age puberty begins,
and factors such as exposure to tomcats, cycling females or increasing
amounts of light will trigger earlier estrus. Although some cats cycle all
year round, most cats in North America cycle between mid-January and
late September.
    The estrous cycle in a female cat is comprised of four stages:
anestrus, proestrus, estrus and metestrus. Estrus is the only time in
which a female will allow copulation and can conceive.
    Proestrus is the short period one to three days before estrus. A
female cat in proestrus may:

     • Show a general increase in her activity.
     • Roll and rub on objects and people.
     • Spray urine.
                                                   Kitten Development   15

    • Lie low to the ground with her tail to one side and knead
      with her paws.
    • Howl or otherwise vocalize.
    • Not yet allow a male to mount her.

    The proestrus period enables a female cat to let males know she is
available! More information about the other stages of the feline estrous
cycle is included in Chapter 11.

A cat becomes an adult during this period. Social play decreases and the
metabolic rate slows in spayed and neutered animals.The cat must take
in fewer calories to avoid obesity, and this is achieved through a switch
to adult maintenance diets. These diets have fewer calories and more
fiber than diets for younger cats.
    The immune system matures and cats have more natural ability to
fight infection.This process continues throughout adult life, but wanes
during the senior years.
    A cat’s personality more fully develops and is based on genetics and
earlier life experiences. Behaviors become more routine. Cats in multi-
cat households assume a position in the social hierarchy of the home.
Chapter 3

Feline Mental Health

Part of the allure of cat ownership is living with a creature who has not
truly been domesticated. The process of feline domestication did not
take the typical course of selective breeding to produce gentleness or
trainability, as occurred with other species. Instead, cat breeding has
gone through periods when it has been selective and periods when it
has been random, depending on whether cats have fallen in or out of
     Cats rely on their natural instincts for hunting, self preservation and
elimination. Many of the behaviors cat owners deem undesirable are
simply manifestations of natural behaviors. Cats instinctively mark their
territory by spraying and scratching, they play roughly with one anoth-
er, and they pounce on and bite their prey. If you really think about it,
many of the ways we demand cats behave are totally contrary to their
     I was taught in veterinary school that cats are not social animals, but
more recent research has disproved this myth. Cats need individual
attention from their owners and are generally better adjusted socially
when they are raised with at least one other cat.You are wrong if you
think your cat doesn’t need you.Although cats can manage staying home
alone all day while you are at work, it’s really not their preference.
                                                                 Feline Mental Health 17

Environmental enrichment and awareness of your cat’s needs are
important factors in making her happy in your home. If left outdoors,
a cat would spend a large part of her day stalking and eating prey.This
activity would provide mental stimulation and challenge. It would also
provide exercise and keep the cat in good physical condition.
    Cats scratch to communicate visually and by scent, and to keep
their nails in shape. Give your cat at least one tall, sturdy scratching post
in an easily accessible area. If she is not given appropriate items to
scratch and then trained to use them, she will seek out alternative
objects in your home.
    Indoor cats don’t have to work to eat, so boredom and obesity can
result.Train cats to perform tricks and reward them with treats.Throw
the treats and let your cat chase them. Consider placing small amounts
of food in several locations and making your cat roam around to eat.
    Create vertical space to keep your cat happy. Cats love to jump up
on things and watch the world from a high vantage point. Jumping up
keeps cats active, and giving them a high perch gives them an appro-
priate place to hang out and retreat from other cats, animals and peo-
ple in a household. If two or more cats must live together in a small
home, cat trees and elevated perches give cats more space, create verti-
cal territory, and decrease the stress of sharing a small area.

     Cats enjoy climbing and having a high perch for sleeping.
18 Guide to a Healthy Cat

     I cannot emphasize enough how important litter box placement
and maintenance is to making a cat happy (see Chapter 1 for more on
litter boxes). An inappropriate litter box is the number one reason cats
eliminate in inappropriate locations. Many feline behaviorists recom-
mend having one box per cat, plus one extra.
     Although cats may play less as they age, play is another component
of good feline mental health. Many cats will play on their own with
toys, but interactive play every day is also very important for your cat’s
mental health. Play relieves boredom and provides exercise. It provides
an outlet for stalking, pouncing and biting behaviors. Don’t give up on
cats who seem uninterested in playing. Search for fishing pole toys
with feathers or laser lights that will stimulate at least a little interest in
     To keep your cat entertained, set up an outdoor bird feeder that
your cat can observe through a window, or install an aquarium. These
items will provide a lot of stimulation to a cat who longs to hunt and
chase, as well as a couch potato.

Trying to understand how a cat perceives the world is difficult.We do
our best to make their lives comfortable, but we do not always proper-
ly meet our cat’s individual mental needs. Changes in the home envi-
ronment or with an owner’s schedule may seem trivial to us, but they
can have a major impact on our feline friends. Cats can manifest their
stress through various behaviors.
     A trip to the veterinary hospital sends some cats into a frenzy of
fearful aggression. Boredom makes some cats engage in destructive
chewing and clawing behavior. They often perform these behaviors
simply to get negative attention from their busy owners. Some cats
overgroom to the point of creating bald patches and sores as a
response to stress.This condition is called psychogenic alopecia. Other
stressed cats spray urine or eliminate inappropriately around the
     Pay attention to your cat and look for signs of stress-induced behav-
iors. Early intervention is the key to preventing unwanted behaviors
from continuing, and to making your cat happier.
                                                    Feline Mental Health 19

Holding and carrying a cat properly is important. Of course you do not
want to injure the cat, and if the cat feels insecure she may injure you
trying to get away.There are various techniques that work well, and you
can master them with practice and experience. If you have children, be
sure to work with them and teach them how to gently and safely han-
dle the cat. (Cats seem to have extra tolerance around children and are
willing to put up with more than they normally would from you.)
     The whiskers and tail of a cat are very sensitive to touch. Do not
hold or pull a cat’s whiskers.A cat’s tail is an extension of her spine, and
if you pull too hard, you can cause damage to the end of the spinal col-
umn where important nerves controlling urination and defecation are
     When working with a cat, it is important to be gentle but firm.
Cats are quite adept at reading human body language. If you are not
confident about your ability to pick up or hold a cat, the cat knows it
and will take advantage of the situation.
     The best way to pick up a cat is to first extend your hand and let
the cat sniff it.This gives the cat a chance to know who you are. Next,
scratch the cat between the ears and along the cheekbones or chin.
Approaching the cat from the side is less threatening than looming over
her. Put one hand firmly behind the armpits of the front legs and lift
the cat up, then scoop up the hind legs with your other hand from
below. Hold the cat gently against your body for additional support. A
cat who feels secure is less likely to struggle.
     It is acceptable to hold a cat, even an adult, by the scruff of her
neck—but please don’t try to lift her off the ground this way. This is
the hold the mother cat used on her as a kitten. Most cats will natu-
rally relax when held in this manner.A large cat may be difficult to hold
well in this way, and you will need to support her hind end.
     You can cradle a cat in your arms by scooping her up with one arm
at the front of her chest and the other arm behind her tail. This posi-
tion should also support the hind legs. For more security, you can hold
the hind legs in this position with your hands.
     Some cats tolerate being carried cradled like a baby. But upside down
cradling is a very submissive posture, and many cats will not allow it.
20 Guide to a Healthy Cat

     Another way to hold a cat is over your shoulder as if you were
burping a baby. In this position, place one hand over the cat’s shoulders
and the other behind her tail and holding her hind legs. Some cats like
to ride on their owner’s shoulders, and this is cute when they are kit-
tens, but may not work when they are larger and heavier.The animal’s
weight and claws can be quite uncomfortable. Be careful if you allow a
cat to jump or climb up on you.
     If a cat is under something and you want to pull her out, grabbing
the scruff and pulling is the safest way—if you cannot entice her out
with a treat or a toy. Do not pull on the limbs. Although cats are pret-
ty tough, most humans could accidentally pull one of their legs out of
     Each cat has a different tolerance level with regard to being held.
Some cats live to be held and carried around. Some will run the other
way if they think you are coming to pick them up. Others will accept
a little holding, but then scoot away at the first possible opportunity. It’s
important to respect your cat’s preferences and understand that, in gen-
eral, cats prefer to be cuddled while they are firmly on the ground (or
the furniture).
     If you have a cat who is scared or injured and you do not feel com-
fortable picking her up in a conventional manner, you might try throw-
ing a towel or blanket over her head first and then trying to pick her
up.When cats cannot see you, they often calm down. For safety reasons,
try to transfer the animal to a carrier or box.


    Whiskers have been called the sixth sense.They are so delicately
    sensitive that if they move 1/2000th of the width of a human hair,
    they will send signals to the cat’s brain.The anatomical term for
    whisker is tactile vibrissae.These touch sensors are used for stalking,
    measuring and warning the cat about unseen obstacles. Damaged
    whiskers lead to misjudgment and fumbling.Whiskers detect wind
    and deflected air currents, and this information helps the cat locate
    her prey. In dim light, cats use their whiskers for navigation. If a cat
    loses her whiskers, she must depend more on sight for getting
    around and hunting.
                                                    Feline Mental Health 21

Cats are creatures of habit, and they generally would prefer that things
stay the way they are. The same holds true when you’re introducing a
new cat to a household where other pets live.This is a situation when
patience is a must. Sometimes all animals involved are amenable to the
addition, and other times your former best friend will have nothing to
do with you or the new cat.
    As difficult as it may be to find the perfect cat for you, it is even
more difficult to try to pick out a friend for an existing cat. I always tell
people that they should be getting another cat because they want one,
not because they think their cat needs a friend. If you get another cat
and she does not get along with the original cat, you are still responsi-
ble for the new cat.
    Cat owners interested in acquiring another cat often ask me
whether the sex of the new addition matters.There are no current stud-
ies showing that cats have a social preference for living with any par-
ticular sex. Many potential cat owners shy away from acquiring a male
cat because they are concerned about urine spraying.This is not a com-
mon problem in cats who are neutered before they reach puberty.
Female cats can spray too, but they rarely do. Both males and females
may eliminate outside of the cat box to mark territory or to show their
displeasure in certain instances. It is very uncommon for cats to spray
or eliminate inappropriately if they live in single or dual cat households,
but the risks increase when three or more cats are present.
    I think it is easier to bring a kitten into a household with an exist-
ing adult cat or cats. In this situation, the territory and dominance of
the resident cats are established, and they are not as threatened as they
would be if they had to compete with another adult cat. Senior cats
may not tolerate a kitten jumping on and bothering them, and they
usually keep their distance. It is a good idea to put a young “pest” away
in another room, if needed, to give an older cat a break.

Tips for Introducing Cats Successfully
For health reasons, a veterinarian should examine a new cat or kitten
before she comes into direct contact with your other cats. She should
be tested for feline leukemia, a potentially fatal and contagious feline
virus. If she is six months or older, she should be tested for feline
immunodeficiency virus (FIV) as well. If the new cat came from a
22 Guide to a Healthy Cat

shelter, a large multicat household or a cattery, it would be wise to iso-
late her from other cats for a minimum of a week to control the spread
of any contagious diseases.
    Jealousy is a problem to address whenever a new cat joins the
household. Dogs and other cats are generally reluctant to share you
with somebody else. Give the existing animals lots and lots of attention
to ease the transition.
    Proper cat introductions reduce conflict and stress. The first time
you bring a new cat home, you should confine her in her own room
with her own litter box, food and water.This enables the other animals
to sniff under the door to begin the introduction. If there is growling
or hissing from either side, talk gently and try to calm the animals.
Ideally, the initial separation should last a week.The next step is to place
the new addition in a carrier in the middle of a common area and allow
the other pets to see and sniff her. If all of the animals are calm, let the
new addition out of the carrier while you supervise everyone. After a
few incident-free, supervised meetings, let the pets to remain in contact
and leave the room; be sure to listen for any trouble. If things go well,
the successful introduction has been completed.
    If you have a dog and are introducing a cat, start with the dog on a
leash.Your new cat may have never seen a dog before, and your dog may
never have had a cat in his house before, and it is hard to predict how
either will react. Most dogs are just curious and may quickly approach
a cat, but doing so can scare the cat. Don’t leave dogs and cats alone
unsupervised until you are sure neither animal will cause problems.
    Dogs like to eat cat food and cats like to eat dog food. Everyone
always wants what the other guy has. This is not dangerous, but each
species has different nutritional needs that must be met. In particular,
cats need a lot more protein than is found in dog food, and cannot live
on a diet that is predominantly dog food.
    Another point to mention is that dogs like to get into litter boxes
and eat cat feces, so getting a covered box or placing it in an area less
accessible to the dog is recommended. Why does this unappetizing
habit occur? Probably because feline diets have higher fat and protein
contents, which leads to richer wastes!
    There is no standard acclimation period with animals. Until you
feel totally comfortable with how all parties are handling the situation,
the new addition should be confined when not being supervised. Any
resident cats should not be immediately forced to share their food,
water or litter box with the new addition. This is another reason for
                                                    Feline Mental Health 23

temporary confinement. In a multicat household, competing for food
can cause problems such as weight gain and aggression.When the new
cat comes out of confinement, each cat should have their own food
dish—for life. Asking cats to eat from the same dish, or to eat in close
proximity from a side-by-side dish, goes completely against their nature
and is just courting trouble.
    Litter box hygiene is always important, but even more so when
there is more than one cat.The best way to prevent inappropriate elim-
ination and encourage proper litter box use is to have a minimum of
one litter box per cat. Although both cats may use both boxes, two
boxes become soiled more slowly than one. Scooping every box at least
once a day is a necessity to keep things clean.

Cats may bite or scratch humans in their own defense—such as when
a child pulls on a cat’s tail—but unprovoked aggression is not accept-
able. Some cats give warning signs that they are about to blow their fuse
by hissing or growling, lashing their tail or twitching their skin, but oth-
ers just strike out.You need to use caution any time you are handling a
cat who has previously shown aggressive tendencies.
    Cats are not dogs, so if you see a cat wagging or thumping her tail,
don’t mistake the behavior for happiness. Cats swish their tails when
they are mad.Watch out!
    One confusing type of aggression some cats demonstrate is petting-
induced aggression. Cats with this behavior will sit contentedly on your
lap and act like they are enjoying being petted, then suddenly they will
turn and bite. Unfortunately, my hospital cat, Henry, does this. This
behavior is seen more commonly in male cats, and the cause is not
known.Two theories are:

    1. Cats don’t know how else to tell you to stop when they are
        tired of your petting, so they bite.
    2. Cats find the petting so pleasurable that they fall into a light
        sleep, but then startle and feel confined, so they strike out.

    You can decrease the chances of being bitten in this situation if you
become more aware of the subtle signs the cat may exhibit right before
biting, and back off.
24 Guide to a Healthy Cat

    Cats can exhibit aggression because they are fearful. I personally am
very familiar with this situation because it happens daily in my veteri-
nary clinic. Owners are shocked when their little sweetheart turns into
a woman-eating lion during her examination. Speaking in a quiet voice
and moving slowly will calm some cats, but others already have their
minds made up and are not going to submit to examination quietly.
Using protective clothing and gloves helps my staff to protect them-
selves in these situations. We hate to see our patients get so upset. It’s
hard on the animal and makes it hard for us to do a thorough job.We
prescribe a mild tranquilizer to be administered before the next visit, if
    Just like people, some cats will redirect their aggression. Your cat
may be stressed or upset by something else, but she takes it out on you
or on another cat in the household. For example, your cat might hear
or smell another cat outside, feel threatened and respond by biting or
hissing at you. Trying to eliminate the source of stress and squirting a
cat with water if she attacks are ways to manage the problem.
    Aggression may also be caused by illness or neurological disease. If
your cat has a sudden behavior change and becomes aggressive, you
should have her examined for medical problems.

Housesoiling and inappropriate elimination are two terms used inter-
changeably to describe urination and/or defecation outside of the lit-
ter box on a horizontal surface. They are not the same as spraying,
which is directed onto a vertical surface.
    Housesoiling is a very frustrating problem for cat owners, because
the cat they know and love is ruining their house.An entire book could
be written about all the options and treatments for this problem, but the
bottom line is that no one can promise a cure. In almost every case the
problem can be solved, but it takes a committed owner and early inter-
vention.The longer the behavior has existed, the longer it will take to
change. I get frustrated myself when owners bring in a cat they have
allowed to eliminate outside of her litter box for years, and then want
the problem quickly fixed because they are getting new carpet. I wish
it could be that simple!
                                                      Feline Mental Health 25

    The keys to eliminating housesoiling are:

     • Ruling out any medical problems with the cat
     • Early intervention to stop the behavior
     • Keeping the litter box immaculately clean
     • Making sure the box is in a convenient location
     • Providing a litter box for every cat in the home
     • Giving the cat a type of litter she likes
     • Using drug intervention when behavior modification fails

    There are so many factors that can trigger a cat to stop using or
only intermittently use her litter box that I use a questionnaire with
owners when they bring a housesoiler in for an examination.An owner
may not detect problems or stresses that the cat is experiencing, and the
situation needs to be evaluated from the cat’s perspective.
    Many steps may be needed to get inappropriate elimination under
control.The very first step, in all cases, is a thorough medical examina-
tion, because housesoiling is often a sign of a medical problem. If the
cat gets a clean bill of health, proper cleaning of the litter box and envi-
ronment are always the next steps. Behavior modification is next. If all
else fails, drug therapy should be considered.

                            CLEAN UP RIGHT

    Never use products that contain ammonia to clean up urine or
    feces, especially if a cat eliminates outside of the litter box. Ammonia
    will actually intensify the odors of the waste products you are trying
    to eliminate. Simple soap and water may seem to remove the smell,
    but your cat’s sensitive nose can probably still pick up the odor—
    which encourages her to eliminate in the same place again.Your best
    bet is to use specially formulated enzymatic pet-odor neutralizers,
    which are available through your veterinarian, in most pet supply
    stores and in many supermarkets.
26 Guide to a Healthy Cat

    There are a handful of drugs that can be used to try to control inap-
propriate elimination. Most of them are safe, even with long-term use,
but the cat should be monitored regularly for side-effects. In some sit-
uations a short course of medication stops the problem. In others the
cat may be on medication indefinitely. Most of the antianxiety drugs
available take one to two weeks to evaluate their effectiveness. Initially
they may make a cat sleepy or dopey, but this effect usually goes away
within four to five days.

Excessive vocalization can be an annoying feline behavior. Some
breeds, such as Siamese, are known for being talkative, and other cats
may vocalize excessively and demand constant attention. A move, trau-
ma or some other significant change in the cat’s schedule can trigger
this behavior. It can occur in older cats who lose their hearing and
vision and become disoriented. High blood pressure, pain or neurolog-
ical disease can also trigger excessive vocalization.
     If you have a young, healthy cat, it can help to establish a routine
where you give the cat your undivided attention for a few minutes
twice a day.This is a good time to involve the animal in interactive play.
     If you have an older animal, a veterinarian should examine her to
rule out any medical problems that may be triggering the behavior. If
no medical problems, such as high blood pressure, are found and the
cat’s senses of vision and hearing are normal, a senile syndrome called
cognitive dysfunction should be considered. Medication is available that
can improve this condition, although it is not currently approved for use
in cats.
     If you have tried everything and the cat won’t stop howling, tran-
quilizers or antianxiety medications may be needed to manage the
Chapter 4

Good Grooming

The beauty of a cat comes not only from his graceful movement but
also from his haircoat. The coats of cats are usually described as short,
medium or long. People like to think shorthaired cats do not shed as
much as longhaired cats, but this is not the case. Unless you have a hair-
less Sphynx cat, all cats shed.The Devon and Cornish Rex breeds have
kinky coats that shed less than others, but any animal with hair sheds—
even humans!
     Healthy cats have good coats and skin. Cats are clean animals, and
most cats groom themselves regularly. But every cat needs some help
taking care of herself; how much help your furry friend needs will
depend on the cat and her coat. Complete grooming of a cat may be as
simple as a weekly brushing and regular nail trimming, or it may
involve combing, brushing, detangling, shaving, bathing and drying.
This sounds like a lot of work, but many cat owners are able to do all
that is needed to keep their cat looking good. For those who have trou-
ble, professional grooming services are available.

28 Guide to a Healthy Cat

Trimming the nails is important for your cat’s good health. Untrimmed
nails can eventually deform a cat’s feet, and can even grow back into the
pads and become very painful. Regular trimming will also prevent your
cat from accidentally scratching you or your furniture, getting snagged
in your sweater or hung up on the rug.
    Proper technique for toenail trimming is to push on the top of the
toe to extend the nail, and then cut off the hooked end with a pet nail
trimmer.When you trim a cat’s toenails, be careful not to cut the quick.
The quick is a bundle of nerves and blood vessels that supply the nail
and will look like a pink line or triangle inside a white nail. If you cut
the quick, you’ll hurt your cat and the toenail will bleed. (If your cat
has black nails, just cut off the part of the nail that curls under.)
    If you are inexperienced, you might want to start off cutting small
amounts of nail and increase over time as you gain confidence with the
procedure. You can have a veterinarian or groomer demonstrate the
technique for you.
    Toenail trimming should be started when your cat is a kitten, so
that she becomes used to it. Cats know when you are not confident, so
if you are having problems with nail trimming, you may want to stop,
regroup and start over a little later. If she senses your anxiety, your cat
will take advantage of the situation by squirming, making it even hard-
er for you to trim her nails.You might consider cutting just a few nails
at a time or trying to cut the cat’s nails while she is napping.

                                                  Cut here

Gently extend the nail by pushing on the top of the toe, then cut beyond the quick.
                                                               Good Grooming     29

                           DOES YOUR CAT
                          HAVE EXTRA TOES?

    Polydactyl is a term used to describe an animal with more than the
    normal number of toes. An average cat has five toes on each front
    foot and four on each rear foot. A polydactyl cat will have more—
    usually six but up to eight to ten toes on each front foot and up to
    seven on each back foot.The condition is caused by a genetic
    mutation that creates the dominant trait and is totally harmless.
       Cats who have extra toes need more nail trimming than average
    cats, because the extra toenails usually don’t get worn down and
    can grow into their footpads.

Cat combs and brushes come in numerous sizes, shapes and colors.
Most people are familiar with conventional combs and brushes, but
mitts, rakes and grooming cloths are also available.What tools you use
depends on the length of coat and the tolerance level of the cat. Many
cats love to be combed, but
others turn into little tigers
when the comb comes out.
Most cats benefit from being
combed or brushed at least
once a week. The hair you
remove helps decrease shed-
ding and hairballs, and also
means less cat hair on your
couch and clothes.
    It is a good idea to intro-
duce a comb or brush to your
kitten within a few days of
bringing her home. Start by
allowing the animal to sniff
(and bite) the tool and see
what it is. Gently comb the cat   It’s not that hard to trim a cat’s nails. Just put
around the neck and back. If      the cat on a flat surface and get a firm grip.
30 Guide to a Healthy Cat

you are met with hissing and claws, stop and talk calmly to the cat. At
first, you may need to hold the cat by the scruff of her neck to keep her
still when you comb her. Short, frequent combing sessions will help
train her to accept, and even enjoy, grooming. Kittens who do not like
being combed may prefer a soft-bristle brush.
     Kittens who are trained to allow grooming are more tolerant of
grooming as adults. It is much easier to handle a two-pound kitten than
an unhappy, 10-pound adult, so it is worth the energy to work on train-
ing your cat while she’s still young.
     If you are having a tough time trying to comb your cat, you might
want to enlist the support of a friend or a relative to help hold her.
Giving a food treat to the cat after a successful brushing session will
positively reinforce the idea of sitting still for grooming. Some cats like
to be combed while they are eating. Eating can provide a good distrac-
tion to the animal and give you an opportunity to get a few strokes in.
(However, some cats like to be left absolutely alone while they eat, and
you must respect your cat’s preferences.)
     The only grooming tool that I think is essential for every cat is a
flea comb, and your cat does not have to have fleas in order to bene-
fit. A flea comb has dense, fine teeth. The most user-friendly flea
combs have easy-to-hold handles and metal (as opposed to plastic)
teeth. A shorthaired cat can be combed from her head to the tip of
her tail with a flea comb, but this tool is too fine to use on animals
with longer hair.
     I routinely use a flea comb on every cat I examine. Its purpose is
twofold: to determine if fleas are present, and to check for scabs, scales
and dead hair. Owners often look at me in amazement when I comb
out a significant amount of hair from their cat, but the fine teeth of the
flea comb are excellent at catching stray hairs and getting below the
surface hair. If fleas are present, flea dirt and live fleas are caught in the
dense teeth of the comb.
     Flea combs can be useful for removing small knots in short hair, but
the pull is too strong for mats on cats with more hair. If your cat gets
food or other substances on her coat, a flea comb can be used to comb
the materials out of the hair.The disadvantages of a flea comb are that
it can break hairs easily if it is used too vigorously, it can be painful to
use on longhaired cats or those with matted fur, and if the fine teeth
become bent, they can scratch the cat.
                                                          Good Grooming     31

For cats with medium to long hair, a medium to coarse metal comb is
needed. Many owners like to use a slicker brush (which has short metal
bristles), but the problem with this tool is that it can ride on top of the
coat and leave hairs matted underneath. Metal rakes are useful for
longer coats, especially if there is a lot of dead hair to comb out.
    One way to ease the stress of combing a hairy cat is to pick small-
er areas to work on, and comb one area a day or every few days. Even
cats who are tolerant of combing have limits to the amount of time
they are willing to put up with the procedure.


    Any cat can have hairballs, but the more hair a cat ingests when she
    is grooming, the more likely she is to cough up a hairball.That’s
    why frequent brushing is your best defense against hairballs.
       Hairballs are normal, and using hairball remedies may decrease
    their frequency but not eliminate them.The main reason to use
    hairball remedies is to prevent a hairball from causing an intestinal
       Trichobezoar is the technical term for a hairball.This word is
    formed from tricho, derived from the Greek, meaning “hair,” and
    bezoar, which is a concretion of materials formed in the intestines.
       Traditional hairball remedies are malt petroleum pastes that come
    in tubes.Today these pastes are found in different flavors, including
    tuna, and even come in pump dispensers.These pastes can be very
    effective, but the petroleum does inhibit the absorption of certain
    vitamins, so it’s important not to give your cat a hairball remedy
    near her mealtimes.
       Psyllium, a type of fiber, is also a useful hairball remedy. It is
    available in premeasured capsules, in bulk form and as chewable
    tablets.These products are available from veterinarians and pet sup-
    ply stores.
       Many “hairball formula” foods have been developed for cats in
    recent years. Most of them contain cellulose, another type of fiber.
    They work well for some cats, but not all. Hairball treats may con-
    tain fiber or have centers filled with lubricants.
32 Guide to a Healthy Cat

Even fastidious cats have a hard time keeping all their hairs in place, and
mats may form in places that are hard for your cat to reach. Mats are
clumps of loose hair that become tangled into the hair that is still grow-
ing.They continue to attract more hair and grow larger and larger, until
they painfully pull and pinch at your cat’s skin.
     Regular combing and brushing is the best way to prevent mats. If
you’re able to comb your pet even a few minutes a day, it can prevent
a more time-consuming and painful problem later on. Mats will grow
to a more unmanageable size if they are not removed.
     It is easy for mats and knots to form on cats with medium to long
coats.To prevent matting, concentrate your combing on the areas more
likely to mat.These areas are the armpits, abdomen, behind the ears, the
tail and under the tail and behind the back legs.
     Unfortunately, cats tend to get mats very close to their skin. It is
tempting to grab a pair of scissors and cut them out, but this is not the
right first step.The best way to remove mats is:

    1. Try to comb the mat out with a coarse metal comb by start-
         ing at the outer edge of the mat and then working in closer to
         the skin.
    2.   If you cannot get a comb through the mat, try to work your
         fingers through it to separate the hairs.
    3.   If the cat is in pain from the pulling or if you are not making
         any progress, work a comb between the skin and the mat.
    4.   Cut the hair along the comb on the side away from the skin.
         This will prevent you from cutting the cat’s skin.
    5.   Gently comb out the shorter remaining hairs.

    It takes weeks to months for hair to grow back. Often the skin
under a mat appears red and inflamed.This is because trapped dirt and
moisture have been irritating the skin. It also occurs if some pulling is
needed during the process of removing the mat.
    Your cat is not going to be happy when you start working on mat-
ted areas. Be careful and stop combing if you are at risk of being bitten
or scratched, or if your cat indicated that you are hurting her. Get help
from a friend or a relative, or turn the job over to an experienced
                                                                        Good Grooming   33

    Most shorthaired cats who groom themselves regularly don’t get
mats, but there are exceptions. This most frequently occurs in older
animals who do not groom themselves enough and in obese animals
who cannot reach many areas on their own.These cats need more rou-
tine combing. A persistent owner armed with a flea comb can remove
most of the matting that forms on a shorthaired cat.
    The matting that forms on shorthaired cats tends to be located
along the end of the spine and at the base of the tail.The hair may be
greasy, dry and scaly all at the same time. This is because a cat distrib-
utes her natural skin oils along the hairs when she grooms herself, and
she can’t reach these areas where mats form. Don’t be surprised if your
overweight cat starts biting or licking the air when you start combing
these areas. Combing these areas is like tickling the cat in a spot she
can’t reach, and boy, does that feel good!
    Regardless of whether your cat has short or long hair, the least
painful and easiest way to remove significant matting is by shaving.
Depending on the location of the matting, the shaving may involve one
area or the entire body. Shaving can cause some discomfort, but not as
much as combing.When cats are severely matted or very intolerant of
grooming, it is best to have the animal sedated so that neither the
groomer nor the cat gets hurt.

A longhaired cat, like this Himalayan, may benefit from a body shave.
34 Guide to a Healthy Cat

Surprisingly, some cats like water and will tolerate baths, but for most
cats a bath is a hair-raising experience. Owners often ask me how fre-
quently their cat should be bathed.There is no set schedule for bathing
a cat, and some cats may never need a bath. Factors to consider when
deciding about a bath are:

     •   Greasiness of the coat
     •   Presence of fleas
     •   Dirtiness of the coat
     •   Smell
     •   Discoloration

    Many cats live to a ripe old age without ever getting a bath, but I
think all cats look and smell better after being bathed. Baths can play a
role in treating some dermatological conditions and in removing exter-
nal parasites such as fleas.
    It is important to use a proper shampoo on your cat. Most sham-
poos for human hair do not have the right pH balance for a cat’s skin
and should not be used. Baby shampoo is acceptable, as are specially for-
mulated pet shampoos. Many of the insecticides found in flea shampoos
can be toxic to all cats or specifically to kittens, so be very careful if you
want to use a flea shampoo. Make sure it is labeled for use with cats and
kittens. With the advent of safe, effective, once-a-month flea preven-
tives, flea shampoos should not be a necessity.
    Before starting a bath, you should trim your cat’s toenails.This will
decrease the potential for injury if the cat gets upset.You should also
comb out any mats in the hair, because they will tighten and be hard-
er to remove after they are wet.
    Here’s how to bathe a cat:

    1. Place a towel or mat at the bottom of the tub or sink so the
       cat does not slide.
    2. If possible, use a faucet that has a sprayer attachment.
    3. Gently wet the cat’s coat with warm water. Hold the cat by
       her scruff, if necessary.
                                                        Good Grooming   35

    4. Massage the shampoo into the coat, rubbing away from the
    5.   Use a toothbrush with some lather to clean the cat’s face,
         being careful not to get any soap in the animal’s eyes. If sham-
         poo does get in the cat’s eyes, rinse with saline solution from a
    6.   Let the cat soak for a couple of minutes.
    7.   Rinse thoroughly with warm water.
    8.   Squeeze the excess water out of the coat and down the legs
         and tail.
    9.   Thoroughly towel-dry the cat.
   10.   Use a blow dryer on low or medium to dry the coat. Higher
         settings can cause burning if you are not careful.
   11.   Comb or brush the hair during the drying process.

    If you are fortunate enough to have a cooperative kitty, the process
will go well. For cats who are scared or anxious, though, the process can
be a disaster if you are not careful. Expect the cat to try to get out of
the sink. Consider wearing an apron or old clothes in case you get
splashed or have to grab a wet cat. Close the door to the room to help
prevent kitty’s escape.

You may be reading this chapter and thinking, “You’ve got to be kid-
ding! There is no way I could ever groom my cat.” If this is true, or if
you have been unsuccessful in your grooming efforts, consider taking
your cat to an experienced groomer.
    Not all groomers like working with cats, so it is important to find
one who does. There are some groomers who have mobile vans and
will come to your house, park in your driveway and work on your kitty
there. Other groomers work in grooming shops, pet supply stores and
veterinary hospitals. There are groomers who have completed courses
on pet grooming and have certificates. There are others who have
learned by experience.
36 Guide to a Healthy Cat

                         PAMPERING A PERSIAN

    Persians are the most popular type of pedigreed cat.To maintain
    their beautiful long coats, they need frequent grooming. Most
    owners are not capable of keeping Persian hair under control
    themselves. Ask other Persian owners about what is involved and
    consider selecting a different breed if you don’t have the time or
    money to have the cat regularly groomed by a professional.

How to Pick a Groomer
The best groomer is one who has worked with cats and has access to a
veterinarian in case of problems. Medical assistance may be required if
the cat is nicked accidentally with sharp grooming tools or if she needs
to be sedated so that the groomer can do a proper job. Many cats freak
out with strangers or are so badly matted that the grooming process is
painful. In these cases sedation is recommended so that neither the ani-
mal nor the groomer gets injured.
    If you have a cat who you don’t feel comfortable grooming on your
own, she should be groomed professionally at least every three months.
The shorter the interval between grooming sessions, the less matting
will occur.

Cat Hairdos
Different breeds of dogs typically have different haircuts, but the same
is not true for cats. Most cats do not get haircuts unless they are matted
or their coats are difficult to manage. There is really only one haircut
for a cat: the body shave. If a cat is shaved, the entire trunk is typically
shaved close, like a crew cut. How far down the legs and tail the animal
is shaved and how much of the neck or mane hair is removed depends
on the cat. If you have never had your cat shaved and you request it, ask
to see a sample of what a shaved animal looks like so that you are not
shocked with the results.
     Don’t be surprised if you take a matted cat to a groomer and body
shaving is suggested. A shaved cat may not look as good to you as a cat
with all her hair, but the pain and discomfort associated with combing
                                                    Good Grooming   37

out a lot of mats may be extreme. The skin is also very traumatized
when there is significant matting, and you could end up with a ragged,
patchy coat after combing. Even after shaving, the coat pattern may
look irregular where mats were removed, but you’ve saved your cat
from a lot of agony.
     Many owners take their cat to a groomer simply for a bath and
brush. A groomer may place cats in cages with dryers on the door
before finishing with hand drying. Groomers usually have assistants to
help them with combing and drying, because four hands are needed to
control many cats. Even though cats do not require bathing, clean,
fluffed hair does look better. Why get your cat mad at you when you
can blame someone else?
Chapter 5

The Best Nutrition
for Your Cat

Food has a high ranking on a cat’s top 10 list. It ranks higher than affec-
tion from you, cravings for catnip and clawing the furniture! Food is a
treat some owners use to bribe their cats or get their cat’s attention.
There is no question that food has psychological importance for both
cat and owner. But of course, food’s physiological importance came
     Is there a magic formula by which to feed your cat? Should you
feed canned food, dry food, semimoist or a combination? Do you need
to be worried about preservatives? Won’t your cat get bored if you feed
him the same thing every day? Can both young and old cats eat the
same food? How much should you feed your cat? All of these questions
are important, and the answers aren’t always clear.
     I am overwhelmed each time I walk through the pet food aisles of
a grocery store or pet supply store. The massive variety of products
seems to grow daily. The pet food market is a multibillion dollar busi-
ness, and a lot of companies want a piece of the pie.

                                           The Best Nutrition for Your Cat   39

If cats were left outdoors to hunt, mice would be their ideal food, sup-
plying all of their nutritional needs. Other prey a cat would choose are
rats, rabbits, birds and insects.
     Cats would probably be healthier if they ate a diet of fresh prey, as
opposed to commercial foods. And this has prompted some owners to
become interested in feeding raw diets to their cats. Most veterinarians
do not favor raw diets, however, because to be formulated properly, they
are very labor-intensive for an owner. Other problems associated with
raw diets include nutritional imbalances, exposure of the human
preparing the food and the cat eating the food to bacteria and parasites
found in raw meat, acceptability of a raw diet to the cat and odors asso-
ciated with preparing and feeding the diet.
     There are three quality categories of commercial cat foods: premi-
um, sold in the grocery store and generic. I would not recommend
generic food because it often does not meet the standards of the
Association of American Feed Control Officials (AAFCO). AAFCO is
the organization responsible for creating practical nutritional recom-
mendations for pet food. Any food you feed your cat should at least
meet these minimum standards, and if it does, it will say so on the label.
     There are many brands of cat food that are sold in the grocery store,
and almost all meet AAFCO standards. The main differences between
these foods and premium diets (which are usually sold in pet supply
stores) are the ways in which the nutrition requirements are achieved.
Premium diets contain higher quality, more digestible and bioavailable
ingredients, which decrease the amount of food the cat needs and the
amount of feces kitty produces.
     Cats are carnivores, so they need high levels of protein in their diets.
Some people call canned food “meat,” and it generally contains more
protein than dry food, but cheaper canned foods may still have a lot of
fillers that are not derived from meat. Most cats like the taste and smell
of canned food, but dry foods offer owners more convenience.The cost
of canned food is also significantly more than dry. While canned food
often has more protein per ounce than dry food, it also contains
between 75 and 80 percent water.
     Once opened, a can of cat food stays fresh for about two to three
days if it’s kept covered and refrigerated. Most cats do not like cold
food, so warming refrigerated food in the microwave for a few seconds
40 Guide to a Healthy Cat

can help increase its odor and palatability. Be sure to stir it to avoid hot
spots. Ideally, cats like their food at room temperature.
     Recent studies have found that cats with certain health problems,
such as lower urinary tract disease and diabetes mellitus, do better on
canned diets. For picky eaters, cats who need to gain weight or those
who need to consume more water, canned food is also a better choice.
Cats who are prone to urinary tract problems may benefit from canned
food because its high water content helps produce more dilute urine.
If you own a cat with lower urinary tract disease, you should avoid
feeding your cat foods with seafood products.These foods contain high
levels of minerals such as magnesium, which can contribute to the for-
mation of crystals in the urine.
     Feeding a combination of canned and dry food to a healthy cat is a
good idea. Cats who eat only canned food tend to build up more
plaque and tartar on their teeth than those who also eat some dry food.
     People today are more aware of their own nutrition and health,
and they want to know about what their pets consume. Most dry cat
foods are chemically stabilized and preserved.The safety of these chem-
icals is constantly being challenged, and pet food manufacturers are
constantly defending their safety—backed up by the Food and Drug

                             DO CATS NEED
                             FOOD ALL DAY?

    We tend to think of cats as grazers who eat a few bites of food at a
    time over the course of a whole day. But free access to food is not
    necessary for most cats, and grazers can get fat if they consume too
    many calories. Dry food can be very concentrated, and feeding your
    cat more than half a cup a day of many brands can cause obesity.
    Most adult, indoor cats tend to gain weight if their bowls are kept
    constantly full.When feeding dry food, check the food label and
    consult with your veterinarian to establish feeding guidelines.Then
    feed your cat two or more smaller meals a day—some canned, some
    dry—to control how much she eats. Another option is to feed a
    little canned food once or twice a day and leave out some dry food
    during the intervening periods.These methods only work if
    portions and between-meal treats are measured and controlled.
                                            The Best Nutrition for Your Cat   41

Administration (FDA). A growing number of companies make “all nat-
ural” foods that contain no synthetic ingredients or preservatives.
Whether these diets will improve your cat’s health and longevity has
not been proven. I have seen many cats who have lived into their 20s
and have eaten regular, commercial dry foods their entire lives.
    If you watch your cat eat, you may see that she does not chew much
on the dry food. Some cats eat too much dry food all at once and
regurgitate it. Cats who regurgitate need to be fed smaller portions.
Mixing in some canned food, or adding some water to the dry food,
can also help. Other strategies to decrease regurgitation are feeding a
larger sized kibble that must be chewed before its swallowed, and feed-
ing in a shallow bowl that more widely disperses the food. Both of these
ideas slow down the pace of eating and decrease regurgitation.

I have already mentioned that normal cats require a high level of pro-
tein in their diets. Proteins are made up of amino acids, and there are
nine essential amino acids that all mammals—including humans—
require in their diets. Cats also require four other amino acids in their
diets: arginine, taurine, methionine and cysteine.
    The typical protein sources used in manufacturing cat foods easily
supplies adequate levels of arginine. Arginine supplementation is rec-
ommended in cases of feline hepatic lipidosis to help support the
detoxification of proteins during metabolism.
    Taurine deficiency became newsworthy in the late 1980s because a
type of heart disease, called dilated cardiomyopathy, was linked to inad-
equate intake. Pet food manufacturers changed their formulations as a
result of this finding, thus virtually eliminating this type of heart disease.
Taurine also plays roles in reproduction, neonatal health and vision.
    The sulfur-containing amino acids, methionine and cysteine, are
needed to synthesize other proteins. Deficiencies of these amino acids
are rare.
    Two other amino acids become essential in certain situations.
Tyrosin is needed for the synthesis of melanin, and a lack of intake or
production of tyrosin leads to a reddish discoloration of black coats.
Carnitine is thought to be important in weight management and
fat metabolism. Supplementation in cases of hepatic lipidosis improves
42 Guide to a Healthy Cat

    Vitamin deficiencies are rare in cats who eat commercial diets. Cats
require high levels of B vitamins, and B complex supplements are rec-
ommended for the diets of sick cats. Unlike other animals, cats cannot
synthesize vitamin A or vitamin D, so they must ingest them in their
diet.When cats are anorexic or have liver disease, vitamin E and K sup-
plements may also be needed.
    Cats, like other mammals, require the essential fatty acid linoleic
acid. It is unknown how well cats are able to metabolize and synthesize
alpha-linoleic acid, so it, too, should be part of their diets. Animal tis-
sues are good sources for these fatty acids, so deficiencies in meat-based
diets are unlikely. Omega-3 and omega-6 fatty acids have received
attention for their roles in inflammation, but their optimal ratios are
unknown at this time. Fatty acid supplements are used frequently for
cats with dermatitis and inflammatory bowel disease.
    After seeing all of the needs that must be met to provide good
nutrition, it is no wonder commercial diets are so widely used.The diet
your cat eats should make him feel and look good, agree with his diges-
tive tract and provide for any special health needs.

Most veterinary nutritionists believe a cat should be given some vari-
ety in foods during her lifetime. Feeding a variety of foods helps make
up for any deficiencies that might be present in a single food or diet.
Kittens develop eating habits and preferences from watching their
mothers. Food preferences develop by the time a kitten is six months
old. If they’re given a variety of foods as kittens, cats are less likely to be
finicky eaters later in life.This makes introducing a therapeutic or new
diet (if needed) easier in the future.
    Cats do not know that there are unlimited choices available for
their feeding pleasure.To prevent your cat from becoming too finicky,
limit the flavors and types of food you offer in a single meal. A smor-
gasbord of different foods is not needed. You can certainly appeal to
their preferences, but try to remember who the boss is!
    Some cats will starve themselves before they would consider eating
food they deem undesirable. Whenever a new diet is offered to a cat,
gradually mix it with the previous diet. Over the course of a week or
two, increase the percentage of the new food. Cats will more readily
accept a slow change, and their digestive tract will be happier, too.
                                           The Best Nutrition for Your Cat   43

    Just like humans, there are some cats who have food allergies and
cannot eat certain kinds of proteins. If your cat vomits after eating cer-
tain foods, look at the ingredients and try offering her something dif-
ferent. Many cat foods have similar ingredients, so you may need to
consult with your veterinarian for help in finding a suitable diet. It can
take six to eight weeks for a diet change to significantly decrease vom-
iting in a cat with food allergies.

Kittens, adult cats and senior cats all have different nutritional require-
ments. Kittens should eat kitten food for the first 6 to 12 months of
their lives. Kitten or growth formula foods are generally more calorie-
dense and have higher levels of vitamins and minerals. Senior cats are
usually less active and diets formulated for them contain fewer calories,
more fiber and less protein. Adult cats do well on maintenance diets,
unless they are pregnant, nursing or have a medical problem that
requires them to eat special foods. Once a cat has been spayed or
neutered, her metabolic rate slows, so to prevent obesity it is recom-
mended to feed a diet that is less than 20 percent fat.
     Many owners are faced with the dilemma of having to feed a
kitten and an adult at the same time.The solution to this problem lies
in the weight of the adult. If the adult cat is trim, leaving kitten food
out is not a problem. If the adult is overweight, the adult mainte-
nance food should be free-fed, and the kitten should be supplement-
ed with kitten food that is fed privately, where the adult can’t get
at it.
     Most special and prescription diets are fine for all adult cats, but may
not be suitable for growing kittens or seniors. Discuss these individual
feeding issues with your veterinarian so that you can tailor a proper
feeding program for your cats.
     Dieting for overweight cats is a challenge. Many “light” feline diets
are available for overweight cats, but these diets are not equal in quali-
ty and some brands have two to three times the number of calories per
cup than others.
     There are two main diet theories for cats. One is to feed a larger
amount of a low-fat, high-fiber diet because it fills them up.The other
is to feed more protein and less carbohydrate because it better satisfies
cats—the Atkins Diet approach.
44 Guide to a Healthy Cat

    To safely put a cat on a weight-loss program, create a diet plan with
your veterinarian, stick with it and take the cat back to the doctor for
follow-up checks. Food-obsessed cats often will eat low-calorie items
such as lettuce, carrot pieces, canned green beans or cantaloupe, which
can also help fill them up.

A cat’s body, like other small mammals, is 60 percent water. And water
is the only beverage a cat needs to drink. Cats normally are not big
water drinkers, and they produce very concentrated urine. An average
cat will consume about eight ounces of water a day, but the amount of
water a cat will drink in a day can vary. Factors that affect water con-
sumption include diet, environmental temperature and activity level.
Cats who primarily eat canned foods will not drink as much water as
those who eat dry foods. This is because canned foods contain more
water than dry foods. When the weather is hot or after thorough
grooming, a cat may drink more.
    Unlike humans, who know they need to stay hydrated when they
are sick, cats do not drink enough when they are sick and they quick-
                                               ly become dehydrated. Cats
                                               often need treatment with
                                               injectable fluids to restore their
                                               hydration when they are ill,
                                               because it is difficult to make
                                               them drink enough water to
                                               keep hydrated.
                                                   Water bowls should be
                                               cleaned daily, and they should
                                               be rinsed and refilled several
                                               times a day. You should also
                                               monitor your cat’s water intake,
                                               especially as she matures. If you
                                               notice that your cat is drinking
                                               more water than usual, this can
Researchers believe cats taste water in a more be a warning sign of diabetes
complex way than we do, which may explain      mellitus or problems with her
why many cats like to drink running water.     kidneys.
                                           The Best Nutrition for Your Cat   45

                                CAT MILK

    As I mentioned in Chapter 2, cats like cow’s milk but it is not good
    for them, because they cannot digest it properly.There is a specially
    formulated cat milk drink called Cat Sip.This product does not
    contain lactose, which is the sugar in cow’s milk that cats cannot
    digest. Cats seem to like to drink this as a treat, but your cat
    certainly doesn’t need it.

    The sense of taste in cats is probably more sensitive than our own.
Some researchers believe that cats like to drink out of running faucets
because they prefer fresher tasting water. If you have a cat who demands
that you to turn on the faucet, you are not alone.These cats sometimes
enjoy a running water fountain; several types are sold at pet supply
    In their search for fresher water, some cats develop the unpleasant
habit of drinking out of toilet bowls.This is really dangerous if you use
the kind of toilet bowl cleaner that automatically dispenses chemicals
into your toilet water. Even if you don’t, various cleaning products can
linger on the bowl, and cats can actually fall in the toilet bowl and have
a hard time getting out. To discourage this behavior, close the lids on
toilets or keep bathroom doors closed.
    Some cats like to drink out of swimming pools. If your cat goes
outside it is difficult to prevent this behavior. But don’t worry; the
amount of chlorine in pool water is generally not dangerous.
    If you do not like the taste of your tap water, you may consider
sharing your bottled or filtered water with your cat. Bottled water is a
profitable industry, and there are companies today who are producing
“designer water” for cats. Distilled water may benefit cats who are
prone to urinary tract problems and readily form crystals in their urine.
Distilling removes the minerals that are normally present in water.
Chapter 6

How Do I Know
if My Cat Is Sick?

Our feline friends cannot tell us how they feel, so it is important to have
some understanding of the signs that a cat is sick. Cats are generally
stoic animals, and often they do not let us know they are sick until the
disease has progressed. Observant owners can learn to identify subtle
changes in their cat’s routine and behavior that may be indicative of
     The difficult part of identifying changes is first figuring out what is
normal for your cat. Cats do not think or act like a human would in
many situations, so many cat activities seem strange to us. An example
is coughing up hairballs. If a human spit up hair it would be very
abnormal, but for a cat an occasional hairball is quite normal.
     This chapter will introduce you to some of the ways you can detect
problems in your cat. It will also help you figure out when you should
consult a veterinarian.

                                       How Do I Know if My Cat Is Sick?   47

Anorexia is a term used to describe a lack of appetite for food.
Veterinarians use this term when owners tell them that the cat is not
eating or eating very little.
    Being finicky and not eating are two different things. Some cats
hold out for their favorite foods and this makes them finicky, but
anorexic cats do not care what you put in front of them.
    If a cat does not eat for 24 hours, you should be concerned. If the
lack of appetite lasts more than 48 hours, you should have the cat exam-
ined by a veterinarian.
    Cats, especially overweight animals, can develop a condition called
hepatic lipidosis if they do not eat. Cats with hepatic lipidosis break
down their body fat for energy, but the fat overwhelms the liver, injures
the normal liver cells and makes the cat sicker. Early intervention with
anorexic cats is needed to stop hepatic lipidosis from occurring. Left
untreated, hepatic lipidosis can be fatal.

When Your Cat Won’t Eat
If your cat is not eating, you need to determine if there is a problem
with his diet or if the cat is sick. Some reasons why a healthy cat may
not eat include:

     •   The food is spoiled.
     •   Ants or other insects are in the food.
     •   You bought the wrong flavor.
     •   There is competition at the food bowl.
     •   People food or treats have affected his appetite.
     •   The food bowl is in a bad location.
     •   The cat has been hunting and eating prey or snacking at a
         neighbor’s house.

   If none of these reasons is valid, it is likely the cat is sick. Reasons
why a sick cat may not eat include:

     • The cat is congested and cannot smell the food.
     • The cat has a fever, causing a loss of appetite.
48 Guide to a Healthy Cat

     • Bad teeth or other dental disease is affecting the cat’s ability
       to eat.
     • Liver or other gastrointestinal disease is causing nausea.
     • The cat is dehydrated and too weak to eat.

How to Make Your Cat Eat
Sick cats do not eat well, so it is important to encourage them. Offer
yummy foods, such as canned cat food, tuna fish, deli meat or meat baby
food. Lightly warming the food for a few seconds in a microwave oven
can help build a cat’s appetite by increasing the food’s aroma. Hand-
feeding, talking gently and petting the cat can stimulate eating, too.You
can hand-feed your cat by offering him some soft food on a spoon or
on your finger and encouraging him to lick it off. If a cat seems unin-
terested in eating, do not leave food sitting out for more than an hour.
Pick it up and reintroduce it a few hours later.
    When none of these suggestions proves successful, a trip to the vet-
erinarian is warranted.Veterinarians may use prescription appetite stimu-
lants or may even force-feed an anorexic cat. Force-feeding is typically
done using a syringe without a needle and squirting some type of strained
diet into a cat’s mouth. For cats who are difficult or too sick to orally
force-feed, feeding tubes can be placed into the esophagus or stomach.

What About Water?
Water intake is extremely important. If a cat (or any animal) cannot
keep water down, he should be taken to a veterinarian immediately.
This can be a sign of an intestinal obstruction.
    A cat who does not eat or drink can become seriously dehydrated
within a day.Vomiting and diarrhea can contribute to water loss lead-
ing to dehydration. If your cat is not drinking, you can give him some
water with a syringe (minus the needle) or an eyedropper, but it is
almost impossible to get enough water into a cat this way.
    Veterinarians can rehydrate cats by injecting a sterile, balanced elec-
trolyte solution under the animal’s skin. This practice is called subcuta-
neous administration. Fluids can also be directly injected into the body
through a vein using an intravenous catheter, commonly known as an
IV. Intravenous treatment requires hospitalization but is necessary for
more seriously dehydrated patients.
                                       How Do I Know if My Cat Is Sick?   49

A warm, dry nose or warm ears does not indicate a fever in a cat.The
only way to be certain about the presence of a fever is by actually tak-
ing a cat’s temperature.The normal body temperature of a cat is high-
er than that of a human:The normal range is from 100.5°F to 102.5°F.
    You may need two people to take a cat’s temperature with a rectal
thermometer. Here’s how to do it properly:

    1. Shake down a glass thermometer so that the mercury is below
    2. Lubricate the tip of the thermometer with petroleum jelly or
       a water-soluble lubricant.
    3. Insert the thermometer into the cat’s rectum.
    4. Hold the cat standing and as still as possible and leave the
       thermometer in place for two minutes.
    5. Remove the thermometer and read the temperature.

    Inexpensive digital thermometers are available at drugstores and can
be used rectally in cats. Human ear (tympanic) thermometers are not
accurate in cats. Special ear thermometers are available for animals, but
they are expensive and are only sold through veterinary distributors.

What Causes a Fever?
In a cat, a fever is generally considered to be a temperature reading
above 103°F. Increased body temperature does not always mean the
animal is sick, but if the cat has a fever you should try to find out why.
An increased body temperature can be due to:

     • High environmental temperature
     • Stress or excitement, such as putting the cat into a carrier and
       taking him to the veterinarian
     • Intense playing or running
     • Bacterial infections
     • Viral infections
     • Seizures due to increased muscle activity
50 Guide to a Healthy Cat

Taking a cat’s temperature with a special veterinary ear thermometer. It may be annoying, but
it doesn’t hurt.

What You Should Do if Your Cat Has a Fever?
If you suspect that your cat has a fever, be sure he is someplace cool.
Do not give any over-the-counter medications made for humans to reduce a cat’s
fever. If the cat is alert and acting normal, check his temperature again
in an hour.You can hose a cat down with cold water to bring down his
temperature, but this rather radical treatment should be reserved for
cases when the temperature is above 105°F.You can also apply rubbing
alcohol to the cat’s footpads to cool him, but if the cat then licks his
feet, he will drool a bit.
     Whenever a cat has a fever, it is best to have the cat examined by a
veterinarian as soon as possible.The doctor will try to determine what
triggered the fever and then offer options for treatment. Cold fluids can
be injected into a cat to cool him down. If a fever persists for more than
24 hours, more extensive nursing care and diagnostic testing are prob-
ably warranted.
                                         How Do I Know if My Cat Is Sick?    51

                               NO ASPIRIN

    Never give a cat aspirin, acetaminophen (Tylenol), ibuprofen
    (Advil) or any other anti-inflammatory medication made for
    humans. Cats lack the enzymes needed to metabolize these drugs,
    and they can be life threatening. If your cat accidentally ingests one
    of these drugs, seek veterinary care immediately.

We’ve come back to the issue of deciding what is normal behavior for a
cat. Each cat is an individual with unique habits and preferences. Owners
of adult cats have a good idea of what is normal for their cat when it
comes to eating, drinking, playing and sleeping; but for a new kitten
owner, these behaviors may not yet be established. Cats are creatures
of habit, so if your normally “bouncing off the walls” kitten couldn’t care
less when you come home from work, he is likely not feeling well. In
general, cats who are sick become quieter than usual and keep to them-
selves or even hide.They seem as if they do not want to be bothered with
regular daily activities.

Sometimes when cats are not feeling well they become irritable. Signs
of irritability include:

     •   Hissing or growling
     •   Striking out with a paw or claws
     •   Biting
     •   Moving away from you when normally they would not
     •   Less tolerance for other people and/or animals in the house

    If your cat becomes more irritable, try to determine if he is not feel-
ing well and wants to be left alone or if the behavior change does not
have an apparent trigger. In either case, you will likely need to have the
cat examined by a veterinarian to see if a more specific cause for his
52 Guide to a Healthy Cat

irritability can be found. A veterinarian can treat any underlying med-
ical problems and work with you to solve behavioral problems.

Failure to Respond
Cats are usually very alert and tuned in to the activities around them.
If your cat suddenly becomes disinterested or unresponsive, this is not
normal. As cats age, their activity level is reduced, but if vision and/or
hearing are not impaired, cats will still react to things around them.
    Diseases that affect the nervous system are not that common in cats,
but they do occur. Any sick cat with behavior changes should have his
nervous system assessed by a veterinarian. Diseases that affect other
organ systems or electrolyte imbalances can also cause behavior changes.

There are many clinical signs a sick cat can exhibit. One isolated
episode of any of the common clinical signs does not indicate a sick cat.
Signs that last more than a day or that progress indicate problems that
are unlikely to be resolved without treatment.
    Every cat owner has a comfort level with evaluating the signs that
their cat shows, but whenever there is uncertainty, consult with your


 Anorexia                               Head shaking
 Bad breath                             Itching
 Bleeding                               Jaundice
 Bloating                               Limping
 Bloody urine                           Nasal discharge or congestion
 Conjunctivitis                         Redness (of skin, eyes, face)
 Constipation                           Seizures
 Coughing                               Sneezing
 Diarrhea                               Straining
 Drinking more than normal              Swelling
 Excessive licking                      Vomiting
 Fever                                  Weight loss
 Gas                                    Worms
                                        How Do I Know if My Cat Is Sick?   53

 Bloody Urine
 Weight-bearing lameness

     Cats are very protective and defensive by nature, so they hide their
illnesses well. Often cats do not let us know that they are sick until a
condition is quite advanced.

There are a few clinical signs that warrant immediate attention. These

     •   Difficulty breathing
     •   Inability to urinate
     •   Uncontrolled bleeding
     •   Jaundice
     •   Inability to stand
     •   Seizures
     •   Vomiting blood

    Signs such as these can be indicative of life-threatening problems. If
you think your cat may have sustained a severe trauma such as being
attacked by a larger animal, getting hit by a car or falling from a roof, get
the cat to a veterinarian as soon as possible, even if he seems to be OK.
    Even if your regular veterinarian closes his hospital at night and on
holidays, he should be able to provide you with a source of after-hours
emergency care.Veterinary clinics have an answering service or message
machine that can give you a phone number for emergencies or refer
you to an emergency clinic. Emergency veterinary clinics can also be
found in the Yellow Pages.
54 Guide to a Healthy Cat

   The cost of emergency services is higher than services provided
during regular business hours. Emergency veterinary clinics provide
aggressive diagnostics and treatments. Be sure to discuss any recom-
mendations with the doctor and try to understand what is being done
and how necessary it is, so that you will not be surprised when you see
your bill.You need to feel comfortable with your animal’s treatment.

Cats are very sensitive to medications, but they can be safely treated
with a few products for humans. It is important to read labels and check
ingredients before treating a cat. Call your veterinarian’s office before
giving your cat any medications. If the animal is not responding to your
care within 24 hours, don’t wait to get help.

Cleaning Cuts
Any small wound or abrasion can be safely cleaned with hydrogen per-
oxide.This solution can fizz and bubble when it comes in contact with
blood, but it does not sting the way rubbing alcohol does.
    Another disinfectant that you may keep around the home is a
Betadine solution. This type of solution has an iodine color and can
cause staining, so be careful where you apply it.

Ointments and Creams
After a wound, puncture or abrasion is cleaned, it is safe to use a triple
antibiotic ointment. One common product is Neosporin, which can be
safely used topically twice daily.
    Hydrocortisone cream or ointment can be applied to a minor rash
that is itchy to a cat.This drug is useful to treat itching and inflamma-
tion if there is no infection, but if bacteria or fungus are present, it can
make an infection worse.
    Cats like to keep themselves clean. If you apply any topical cream
or ointment to a cat’s skin, expect the animal to lick it. Using topical
products sometimes draws a cat’s attention to an irritated area and the
skin can become more irritated if the cat licks it too much. Sometimes
cats don’t know when to stop.
                                        How Do I Know if My Cat Is Sick?   55

Cleaning Around the Eyes
Many cats, especially Persians, have some discharge from the eyes, which
forms in the corners of the eyes and can be hard to remove. It is best
just to use warm water on a cotton ball around the eyes and nose. A
saline solution made for people with contact lenses can also be used to
clean the eyes and nose. It is safe to use a mild boric acid solution
around the eyes and nasal folds.

Kitty Has an Upset Stomach
If you have a cat who is vomiting but is still able to hold down water
and small bits of food, you can try treating him with Pepcid AC. A cat
can take one-quarter to one-half of a 10-mg tablet once a day. If you
think the vomiting is due to a hairball and you do not have any type of
hairball remedy, try putting half a teaspoon of white petroleum jelly on
the cat’s nose. Cats hate to have a dirty nose and will lick it clean, there-
by ingesting some lubricant.
    Some types of diarrhea will respond to treatment with Kaopectate
or Pepto-Bismol. Both of these formulas currently contain bismuth
subsalicylate, which must be used cautiously in cats. A five-pound cat
can take one teaspoon (5 ml) of these medications twice a day for two
or three days.
    One other drug for humans that can be safely used for cats for a
short period is Imodium A-D.This drug should only be given in small
amounts; the dose is one-eighth of a teaspoon for a 10-pound cat, three
times a day, for no more than two days.
    Again, it is always best to call your veterinarian before giving your
cat any type of medication.

Kitty Is Constipated
It is normal for a cat to have a bowel movement at least once a day. Cats
who pass less frequent, dry stools need help.You can use a hairball rem-
edy for mild constipation, because it acts as a lubricating laxative.
     Cats can become constipated due to diet, dehydration or just by
grooming themselves and ingesting too much hair. If you think that
your cat is constipated, you can buy a premeasured veterinary psyllium
56 Guide to a Healthy Cat

                            WATCH YOUR BOY

    There is a subtle posture difference when a cat urinates or defe-
    cates. If you observe your male cat straining to eliminate and you
    are not sure he is constipated, you should consult with a veterinari-
    an immediately. Male cats can get life-threatening urinary block-
    ages, and straining to urinate may be the only sign they show.

product or you can get plain Metamucil and give your cat one to three
teaspoons a day. One tablespoon of canned pumpkin two to three times
a day also works as a laxative.

Kitty Gets Carsick
Whether it is stress or motion sickness, some cats vomit when they trav-
el in a car.You can give a cat half a 25-mg tablet of Dramamine 30 min-
utes before travel to calm his stomach.This drug is an antihistamine, so
your pet may get sleepy. Removing your cat’s food and water for a few
hours before travel also decreases the likelihood of vomiting during a
car ride.

Kitty Was Stung by a Bee
It is unusual for a cat to have an anaphylactic reaction to an insect bite
or sting, but it is normal for redness and swelling to occur at the site.
(An anaphylactic reaction is a severe and potentially fatal allergic reac-
tion that can occur within seconds of contact to an allergen.)
     Benadryl can be given to cats to help prevent the localized allergic
reaction that results from a sting.You can give half a 25-mg tablet to a
cat or 12.5 mg of the liquid. Be sure the medication you are using is
diphenhydramine only, because many antihistamine preparations also
contain acetaminophen, which can be life-threatening to a cat.
     Chlor-Trimeton, the brand name for chlorpheniramine, can be used
for cats. It comes as a 4-mg tablet and a cat can take half a tablet, twice a
day.This antihistamine can be used for an allergic reaction or for itchy skin.

Encounters With Oil
Cats who go outside often crawl into spots they shouldn’t. One of the
possible results is that they can become covered in oil or grease from
                                         How Do I Know if My Cat Is Sick?   57

the underside of a car.These products will make the cat sick if he licks
much of them off himself. Regular cooking oil is also too much for a
cat to groom away himself.
    A safe way to remove grease or oils from a cat’s coat is to bathe the
animal in Dawn dishwashing liquid. It is normally not recommended
to use any type of detergent on a cat, but this one is safe because it does
not contain phosphates, which are dangerous to cats.

One of the challenges of feline medicine is getting medications into our
patients. As most cat owners know, their loving kitty can turn into a
wild animal when it comes to taking medicine.There are some tips that
can make medicating easier.
     The most important aspect of getting medicine into a cat is the
confidence of the owner.This may sound strange, but believe it or not,
your cat knows when you are intimidated and will take full advantage
of the situation. A positive attitude about getting the medicine into the
cat’s mouth is necessary for success. If you start the process with doubts,
you will likely fail.

There Must Be an Easier Way
When I dispense medication to a client, if there are alternatives, I will
ask if they prefer liquid or tablets. If a client is unable to give their cat
the medication I prescribe, the cat may not get well, so I need to try to
make medicating the cat as easy as possible for the owner. If an owner
has not medicated the cat before, a doctor or staff member will give the
cat the first dose and demonstrate the procedure.

                            MEDICATION TIPS

    Varying the medicating routine can help. If you give medicine at
    the same time each day and go through the same preliminary steps
    to prepare it, your cat may get smart and be out of sight when it’s
    time to give it to him.
       Giving a treat as a reward after medicating can serve as positive
    reinforcement to the cat.
58 Guide to a Healthy Cat

                                                  Medicating a cat is easier if
                                             you put the animal up on a
                                             table or a countertop. By doing
                                             so, you are taking the cat off his
                                             turf and giving yourself an
                                             advantage. The harder you try
                                             to hold a cat down to medicate
                                             him, the more he will resist, so
                                             minimal restraint is best.
                                             Wrapping a cat in a towel like a
                                             baby is necessary in some cases.

                                             Liquid Medication
                                                 Liquid medications can be
To administer liquids, insert the dropper into   dosed with either an eyedrop-
the corner of the cat’s mouth and squirt slowly. per or a syringe without a nee-
                                                 dle. How quickly you will be
                                                 able to squirt the medicine into
the cat’s mouth depends on the volume that is administered. Small vol-
umes, up to 0.5 ml, can usually be given in one squirt. Larger volumes
may need to be split into three or more squirts, to give your cat a chance
to swallow.You do not need to pry a cat’s mouth open to give liquids.
Simply insert the tip of the dropper into the corner of the mouth, lift
the cat’s chin and squirt slowly.
     Owners frequently ask if they can mix the liquid medication into the
cat’s food. I generally do not recommend this, because cats have a great
sense of smell.When they detect a foreign substance in their food, they
will not eat. Many of the liquid antibiotic drops are fruity and have sweet
tastes and smells.They are not the perfect complement to a tuna dinner.

Tablets and Capsules
Tablets or capsules can sometimes be crushed and successfully mixed
into food, but learning how to directly pill a cat is better.When I teach
owners to give pills, I ask whether they are right- or left-handed and
then demonstrate with the same hand they will use. For example, I tell
right-handed people to put the cat on a table parallel to their body with
the cat’s head pointing toward their right side. The cat’s head needs to
be grasped with the left hand around the cheekbones, and then tilted
                                                How Do I Know if My Cat Is Sick?               59

 To administer a pill, first grab the cheek-   . . . point the nose toward the ceiling . . .
 bones . . .

 . . . open the lower jaw . . .                . . . then pop the pill in over the tongue.

so that the cat’s nose is pointing toward the ceiling. When done cor-
rectly, the cat’s mouth will automatically open, and the more coordi-
nated right index finger can pop the pill over the back of the cat’s
tongue while the middle finger holds the lower jaw down. In this situ-
ation, you are not opening the cat’s mouth with your hands; you are
using leverage to position the mouth open. (A left-handed person
should turn the cat the other way and reverse the hand positions.)
    Research has shown that if a pill or capsule is not followed with a
swallow of water, it can remain in the esophagus for hours. Certain pills,
such as the antibiotic doxycycline, cause severe irritation to the esoph-
agus if they get stuck. If your veterinarian does not give you one, ask
for a small syringe to squirt water into your cat’s mouth after pilling.
60 Guide to a Healthy Cat

A pill gun can help you give your cat his medication.

    Many cats will gag and foam after being medicated.This can be due
to the bad taste of the medication, not swallowing initially or stress.
Foaming is only rarely due to an allergic reaction to the medication, so
do not panic if your cat begins to drool.
    Plastic pill guns are available if putting your finger into the cat’s
mouth is dangerous or unsuccessful. Ask your veterinarian for one of
these tools if you think you need it. Coating a pill with butter is anoth-
er option. It will make the pill taste better and slide more easily down
the throat. Some cats will lick up pills that are coated in hairball lubri-
cant, because they like the taste of the lubricant so much.

Doesn’t It Come Another Way?
More and more veterinarians are using compounding pharmacies.
These pharmacies will take medications and reformulate them into liq-
uids that cats prefer or into capsule sizes that are easier to administer.
Some compounding pharmacies create medicated chews that are fla-
vored treats containing medication. I must confess that one of my own
cats is extremely difficult to medicate, and this form has been the
answer. If you are having difficulty giving your cat a medication, find
out if it can be reformulated.
                                       How Do I Know if My Cat Is Sick?   61

                            DON’T GUESS

    Never administer any kind of medication to your cat without first
    consulting your veterinarian. Do not assume a remedy that has been
    recommended in the past for a particular symptom will again be
    appropriate if the same or a similar symptom appears. Many medical
    conditions resemble one another, but their treatments may be very
    different. Don’t guess at what treatment is right for your cat.

     Using a compounding pharmacy can add to the cost of the med-
ication, but it’s worth it if you are then able to get the medicine into
your cat.
     Another form of medication becoming more widely used is trans-
dermal.The medication is made into a cream that is applied to a hair-
less area, such as the inside of the ears.The biggest problems with trans-
dermal medications are that they are not uniformly absorbed through
the skin, there is no easy way to measure whether they are reaching
therapeutic levels in the blood and it is not known if they are bio-
chemically changed when they are absorbed. At this time, routine use
of transdermal medications is cautioned except in cases where a
response can be measured, such as lowering thyroid hormone levels in
the blood of cats treated with transdermal methimazole.
     A final option for the difficult-to-medicate patient is taking him to
a boarding facility where trained staff administer the medication prop-
erly. However, sick cats seem to do better at home, where the stress lev-
els are lower than at a boarding facility. So if you can medicate your cat
yourself at home, it’s worth the effort.
Chapter 7

How to Choose a

Most veterinarians have earned a four-year undergraduate degree and
then attended veterinary school for four more years to earn their doc-
torates. All veterinarians receive similar basic training in veterinary
school, and after graduation pick the type of practice and job they want.
Veterinarians are well-educated professionals, and each has their own
personality and level of experience.
    If you have other pets or have had other pets in the recent past, you
may have already developed a good relationship with a veterinarian. If
you don’t already have a vet, is a good idea to familiarize yourself with
a veterinary clinic so that you can get your new cat checked out right
away. If you have a positive experience, this clinic will be a resource for
questions or problems that may occur later on.

If you live in a metropolitan area and look in the Yellow Pages, you
will see listings for numerous veterinarians. How can you choose the

                                             How to Choose a Veterinarian   63

perfect one? There are many factors to consider, and each of them will
have a different value to you.

We all have busy lives, so we often choose to work with businesses that
are conveniently located for us. Each individual is willing to drive a cer-
tain distance to buy something or to receive a service, and this distance
can vary depending on the situation.The same is true for obtaining vet-
erinary care.
    Depending on where you live, real estate costs and the availability
of good locations will determine where veterinary practices are found.
I think location is a valid reason to choose a veterinary clinic, because
you are more likely to use services that are easier to obtain.You might
want to consider investigating veterinary clinics that are close to your
home or work, or are located along the way.

Face Value
The way a veterinary facility looks is a reflection on the philosophy of
the clinic owner. A neat, clean facility requires more maintenance and
care, which shows that the clinic is kept to a certain standard.You may
infer that the doctors will want to take extra care and effort to treat
your cat, because they care about appearances.
     Consider visiting a veterinary clinic and touring the facility before
bringing your cat there. If a doctor is proud of the clinic and how it is
run, this should not be a problem, but it is best to call ahead so that you
don’t show up in the middle of an emergency.
     A bigger facility is not always a better facility.The size of the facil-
ity is not as important as what it contains. A basic veterinary clinic has
a reception area, exam rooms, a treatment area, a ward for cages, a sur-
gery room, an isolation area, a pharmacy and the veterinarian’s office.
     First impressions are always important, but they need to be put in
perspective. If you enter a veterinary hospital and there is a strong urine
smell, it could be because a tomcat was just in as a patient (which is not
a problem), or it could be due to urine-soiled floors and dirty litter
boxes (which definitely are problems). Dirty counters and floors don’t
look good, and they may make you question the cleanliness of the areas
where your cat will be treated. Do remember, though, that it is hard to
64 Guide to a Healthy Cat

control hair and debris in the middle of a hectic day at a veterinary

Is This a Full-Service Clinic?
Most veterinary clinics offer a variety of services, including:

     •   Behavior consults
     •   Boarding
     •   Dentistry
     •   Flea control
     •   Grooming
     •   In-house laboratory
     •   Medical care
     •   Nutritional counseling
     •   Pharmacy
     •   Surgery
     •   X rays

    Some clinics also offer ultrasound, endoscopy and laser surgery.
During the course of your cat’s lifetime, there is a good chance she will
need most of these types of services at one time or another. Having a
competent full-service facility makes your life a little easier. If you use
multiple services, the staff and doctors will become familiar with you
and your cat and will be able to serve you better.
    Depending on the size of the facility and the staff, services such as
boarding and grooming may be available. Before boarding your cat, I
recommend checking out the boarding area. Cages vary in composition
and size, and you will want to have a good idea of the accommodations
offered. If the cages are small in a boarding facility, find out if there is any
opportunity for a cat to get out and stretch.The cleanliness and ventila-
tion of the boarding area are more important than the size of the cage.

What About Referrals?
When choosing a veterinary clinic, it is a good idea to ask friends and
neighbors who have cats for recommendations. You can consult with
                                             How to Choose a Veterinarian   65

your state or local veterinary association, and you can even search for vet-
erinarians who have a special interest in cats by browsing the web site of
the American Association of Feline Practitioners (
    A veterinary clinic’s reputation is very important, and conscientious
doctors want to be respected in the community. If someone tells you to
avoid a clinic, find out specifically why and evaluate the validity of the
reason. It is always best to make the final judgment yourself.

All of the factors I have just discussed are important when choosing a
veterinary facility, but I think the most important factors are the cus-
tomer service and communication offered to clients by the veterinarian
and clinic staff.These less tangible qualities require extra effort and care.

Effective Communication
A client must be able to have effective communication with the clinic
staff and veterinarian. Clear lines of communication will ensure that
your cat receives the care you want, and that best service and treatment
options available can be recommended.
     Many people call around before deciding to use a veterinary clinic,
and a decision to use a facility may be based solely on their conversa-
tion with a receptionist. If the receptionist is knowledgeable and friend-
ly, you may feel comfortable going there without knowing anything
about the veterinarian. This is a good example of how much a first
impression can influence you. If you want to know about the doctor
and the staff and get more information, just ask. A good veterinary
receptionist spends time listening and talking to clients.

Was This a Good Experience?
During your first visit with the veterinarian, you can evaluate your
experience by answering the following questions:

     •   Did   the doctor handle your cat kindly and compassionately?
     •   Did   you find the doctor easy to communicate with?
     •   Did   the doctor have a professional appearance?
     •   Did   the doctor listen to you?
66 Guide to a Healthy Cat

     • Did you understand your cat’s diagnosis and the recommended
     • If medication was prescribed, did the doctor or staff show you
       how to administer it properly?
     • Did the doctor spend enough time with you and answer all
       your questions?

     A good veterinary clinic will have a competent support staff com-
prised of receptionists, technicians and assistants. These staff members
will be able to answer most of your questions or find out the answer if
they are not sure. The veterinarian may not always be available to
answer your questions outside of a scheduled visit, so it is worth asking
a staff member.You might be able to get help right away.
     The most highly trained staff member at a clinic, aside from the
doctor, is the licensed animal health technician.These technicians have
been educated in this specialty, have passed a certification exam and are
legally able to perform many procedures.Their knowledge and training
in animal care are comparable to those of registered nurses.

Does Price Matter?
Each veterinary clinic will have different prices for the services they
offer. Veterinarians set their prices based on many factors, including
facility, staff, level of expertise and continuing education, location, anes-
thesia and products used, and competition.
     Some clinics try to bring you in the door by quoting a low price
over the phone but then tack on extra costs for ancillary services that
they require. It is important to try to compare costs for the exact same
services, using the same drugs and techniques, if you are shopping
around by phone and trying to decide which clinic has the best prices.

Do You Get What You Pay For?
I may be biased, but I do believe a good veterinarian is a professional
who has to charge a fair price to be able to offer you high-quality serv-
ices. If you want to have a procedure performed on your cat, you need
to decide if price or quality is the most important issue.When low prices
are charged, something has to be sacrificed.When fair prices are charged,
you should be getting the best care. Note that veterinarians will often
try to work out a payment plan for expensive, nonroutine procedures.
                                              How to Choose a Veterinarian   67

                            GET IT IN WRITING

    If you are dropping a cat off for a procedure, or if a veterinarian
    recommends multiple treatments or procedures, ask for a written
    price quote if you’re not offered one.This will protect both you
    and the veterinarian by ensuring that you both have the same

    At a vaccine clinic, you might wait in line while a veterinarian goes
down the row and injects animals without looking at them. Of course,
getting a vaccine in this manner is relatively inexpensive, because no
expertise or care is provided and there are no costs for maintaining a
veterinary hospital. However, your questions won’t be answered, and
you could even be inadvertently hurting an animal who is not in good
health.Taking your cat to a vaccine clinic may also stress her more than
a regular veterinary visit, because she is not protected in a room by
herself without other animals around. In this type of situation, you are
getting what you pay for—not much.

Your Cat Is Unique
As I will describe in Chapter 8, the annual physical exam and consul-
tation you have with a veterinarian will greatly benefit your cat’s
health and improve her longevity. These visits are certainly more
important than a rigid vaccination schedule.There is great value to the
information your veterinarian can provide when assessing your cat
individually. Aside from the physical exam, you have a chance to dis-
cuss your cat’s behavior and nutrition. There is also value in the doc-
tor’s observations of trends in your cat’s weight, body condition and
general health.
     Many clinics offer wellness plans for cats.These plans are tailored for
certain life stages.Wellness plans can provide a package of services at a
discounted price rather than paying for each service separately. The
plans are good deals if your cat can benefit from the included services
but not if there are unnecessary add-ons. If you choose a wellness plan
from a good veterinarian, you might be able to detect problems
with your kitty as they arise and begin treatment at an earlier and more
beneficial stage.
68 Guide to a Healthy Cat

Veterinary Specialists
Although all veterinarians graduate from veterinary school with the
same degree, some decide that they want to become more highly
trained in a particular discipline and attain board certification.
Currently there are 36 specialties in which a veterinarian can become
board certified. About 11.5 percent of the approximately 65,000 vet-
erinarians in the United States are board certified.

What Is a Feline Practice?
Veterinarians have the option of working on one or many species.
Regular small-animal and mixed-animal practices are able to capably
handle feline patients, but with the increasing popularity of cats as pets,
many veterinarians are dedicating their practices strictly to felines. Any
veterinarian can become a feline practitioner simply by treating only
cats, so if you want to differentiate among veterinarians, you may want
to check other credentials.
     If you are interested in a feline-only practice, it’s a good idea to con-
tact the veterinarian and investigate what makes that practice special. A
veterinarian can affiliate with three different organizations related to
feline medicine.They are:

     • American Association of Feline Practitioners (AAFP)
     • Fellow Membership of the AAFP
     • American Board of Veterinary Practitioners (ABVP)

     Any veterinarian can affiliate with the AAFP and receive current
information on feline care through their newsletters and conferences.
The Fellow Membership is a subgroup within the AAFP comprised of
veterinarians who have completed certain amounts of continuing edu-
cation and have belonged to the AAFP for three or more years. Fellows
are given the opportunity for even higher levels of continuing educa-
tion in feline care and are involved with research grants and feline prac-
tice guidelines.
     If a veterinarian truly wants to call herself a “feline practice special-
ist,” the only way to achieve this status is by becoming board certified
through the ABVP. Becoming board certified requires a lot of work and
dedication, and I think it shows the optimal commitment to feline
                                              How to Choose a Veterinarian   69

                    HOW DO YOU FIND A BOARD-
                      CERTIFIED SPECIALIST?

    Board-certified specialists usually list themselves as such in their
    Yellow Pages listing.Your regular veterinarian can refer you to one
    if you ask. If these options are unsuccessful, you can contact the
    AVMA at
    aboutvets/vetspecialists.asp or call (846) 925-8070. Local veterinary
    associations also have listings of specialists in their areas.

    To become board certified in feline (or in canine and feline prac-
tice) through the ABVP, a veterinarian must have been in practice at
least six years, completed a certain amount of continuing education,
obtained letters of recommendation, written publishable case reports
and passed a certification exam.

What if Your Cat Has a Special Problem?
Your regular veterinarian may not have the facilities or the experience to
handle certain diseases your cat may face. In these situations, they may refer
you to a board-certified specialist. Or you may decide yourself that your
cat needs a second opinion, and it is always best to get one from a spe-
cialist. Some board-certified specialists have their own private practices,
some work in groups and others work at veterinary teaching hospitals.
     Some of the board-certified specialists who are frequently consult-
ed are internists, surgeons, neurologists, ophthalmologists, dermatolo-
gists, cardiologists and oncologists. If you live in a metropolitan area, it
is very likely one or more of each of these veterinary specialists is avail-
able in the surrounding area.

Emergency Providers
There are veterinarians who offer emergency services themselves and
others who refer clients to emergency clinics that are only open after
hours and on weekends and holidays. Some emergency facilities
employ veterinarians who are board certified in emergency medicine
and critical care. Make sure you know where the local emergency clin-
ic is now; trying to find out later, when your cat is having an emer-
gency, can be harrowing.
70 Guide to a Healthy Cat

    In a true emergency, if possible, take your cat to a facility that has a
veterinarian and staff already on the premises and ready to help. The
cost of emergency services is usually significantly higher than those
received during regular business hours, but the same is true in human
    Even though you may not be thinking clearly in an emergency, try
to understand the diagnosis and the treatment options available. Question
the veterinarian if you are unsure and be clear on your choices before
making decisions.

Holistic Veterinarians
Aside from offering typical Western medicine, there are some veteri-
narians who practice holistic care. I will be the first to admit that tradi-
tional medicine and the tools that are currently available cannot cure all
health problems. Because of this, some veterinarians are turning to
alternative medicine.
    Types of alternative veterinary care include:

     •   Acupuncture
     •   Chiropractic
     •   Dietary supplements
     •   Herbal remedies
     •   Homeopathy
     •   Nontraditional diets

    If you seek alternative care, find out how the veterinarian has gained
their knowledge. There are organizations comprised of veterinarians
interested in holistic care, and some do have certification programs.You
can learn more about them on the web site Many
of the treatments may be effective, but there are not many conclusive sci-
entific studies supporting their efficacy.

           10:28 pm, Feb 13, 2005
Chapter 8

Annual Health Care

Although cats are said to have nine lives, they only have one, and you
can help that one along. In the wild cats do a good job of taking care
of themselves, but housecats live much longer than their wild cousins.
    The quality and length of a cat’s life can be extended by routine
health care. By making sure your cat receives regular veterinary exam-
inations, needed vaccines, dental care and parasite control, you can offer
your cat the best preventive health care.

Cat owners often ask me what they can do to provide the best possible
care for their pet. I tell them two things: keep him indoors and be sure
a veterinarian examines him at least once a year. Good owners can be
very observant about their cats and notice important changes, but a vet-
erinarian can objectively evaluate the animal regularly. It is difficult for
owners to assess subtle changes, such as weight loss that occurs gradu-
ally over a period of time, but a veterinarian can consult records and
monitor trends.

72 Guide to a Healthy Cat

What’s Involved in an Annual Exam?
A veterinarian should examine a cat annually, from the tip of his nose
to the end of his tail. Each doctor may have their own routine when
conducting a full physical exam, but the best exams are thorough
exams. A full physical exam should include:

    •   Measurement of body weight
    •   Measurement of body temperature
    •   Evaluation of the eyes, ears and nose
    •   Opening the mouth and assessing the teeth and gums
    •   Palpation of external lymph nodes
    •   Evaluation of the coat and skin
    •   Evaluation of muscle tone and body condition
    •   Listening to the heart and lungs with a stethoscope
    •   Examination of the legs, paws and claws
    •   Palpation of the abdomen
    •   Examination of the rectum and genitalia
    •   Examination of the tail

     Depending on the individual cat and how cooperative he is and the
skill of the veterinarian, this examination can take anywhere from 2 to
10 minutes. In most situations, a veterinarian can conduct the exam
without help, but when the patient is wiggly, scared or aggressive, more
hands are needed.
     When cats are hot or frightened, they are only able to sweat from
their feet, because the footpads are the only body parts that contain
moisture-secreting sweat glands. If you notice damp footprints on your
veterinarian’s exam table, you will know why.

Does It Hurt?
A routine physical exam is not painful to your cat. If the cat squawks
and squirms, he is probably just resisting restraint rather than showing
discomfort.Animals who have not been fully examined before by a vet-
erinarian are generally less cooperative than those who previously have
been examined, but some cats are so frightened that they act worse at
each successive veterinary visit.
                                                         Annual Health Care   73

                            A TRANQUILIZER
                               MAY HELP

    If you have a cat who acts up when taken to a veterinary clinic,
    you should consider medicating him beforehand with a mild
    tranquilizer. It is not good for the cat to be stressed, and it is more
    difficult—if not impossible—for the veterinarian to do a good job
    with an uncooperative patient. Let your vet know if you have
    tranquilized your cat. Also be sure to warn veterinary staff before
    they handle your cat if he has a history of fractious behavior.

    Let the professional veterinary staff handle your cat during any vet-
erinary visit. Many animals become scared and defensive when they are
outside their own homes and become fractious. Owners are often bit-
ten or scratched by their own cats when they try to help hold the ani-
mal during an exam. Experienced animal assistants and veterinarians are
trained to manage these situations. The best way you can assist is by
talking to your pet in a calm, reassuring voice.
    At the end of a physical exam the veterinarian should discuss any
abnormal findings and assess the general health of the cat. If you do not
understand what the doctor has told you, be sure to ask questions. I like
it when clients ask me questions, because then I know that they are
paying attention to what I have told them.
    I also like it when clients come to the physical exam appointment
armed with questions.A veterinarian and her staff should be a resource
for information on all aspects of caring for your cat, including nutri-
tion and behavior.Write down any questions you have on these issues
and bring them along to discuss during your cat’s annual physical
exam.This prevents you from going home and wishing you had asked
the doctor something about your cat that you forgot during the

Testing for the feline leukemia (FeLV) and feline immunodeficiency
(FIV) viruses may be part of an annual exam.Your cat’s status regarding
these two viruses should be known.There is an in-clinic screening test
for these viruses, and it only takes a few drops of blood and 10 minutes
74 Guide to a Healthy Cat

to get results. If the result is positive, blood is sent to a laboratory for a
confirming test.There are false positive results, especially for FeLV, so no
decisions should be made about a cat until a second test proves or dis-
proves the first result.
    Cats most at risk for these viruses are strays, pet cats who go out-
doors and cats who live in households with FeLV– or FIV–positive cats,
since fighting and direct contact are the main routes of transmission.
Although vaccination helps protect cats, those with a high risk for
exposure should be regularly tested.

Vaccines are an important aspect of preventive health care. However,
many people wrongly believe that vaccines are more important than
the hands-on exam by the doctor. Low-cost vaccine clinics have flour-
ished on this premise, and as a consequence many cats do not receive
adequate health care.
    For years, owners have mistakenly believed that vaccinating their cat
every year was the best they could do in terms of health care, but this
is not the case. Studies show that vaccinating cats annually may not be
necessary. Some cats have adverse reactions to vaccines and are better
off without annual boosters.Vaccinations are a complex subject and will
be discussed in Chapter 9.

In a perfect world, cats would brush their teeth every day just like we
do.The reality is that cats cannot brush their own teeth, and many own-
ers are not willing, too busy or don’t know how to brush their cat’s
teeth. Like humans, cats develop dental disease as plaque and tartar build
up on their teeth.This can progress to gingivitis, which is inflammation
of the gums.
    As dental disease progresses, it can cause bacteria to enter the cat’s
bloodstream and affect other parts of the body. Some experts attribute
the frequent occurrence of kidney disease in senior cats to long-term
exposure to bacteria in the blood. Dental abscesses and infected jaw-
bones may also be a result of dental disease.
                                                          Annual Health Care   75

Brushing Your Cat’s Teeth
You can brush your cat’s teeth, and there are many different products
to use on cats. If you are able to brush your cat’s teeth at least once a
week, it will deter plaque and tartar buildup and therefore decrease
dental disease. Here are some tips to follow for brushing your cat’s

    • Start brushing your cat’s teeth at a young age to get the cat
      used to it.
    • Use a small bristled pet toothbrush or fingerbrush without
      toothpaste during your first attempts.
    • Try to rub the cat’s teeth at the gum line two or three times a
      side, both upper and lower teeth.
    • Add a pet toothpaste to the brush if you are meeting with

    Do not use toothpaste made for humans on cats. Toothpaste for
humans is not meant to be swallowed. Pet toothpaste can be swal-
lowed and will not cause problems when ingested. Oral rinses or
wiping with enzymatic pads are alternative methods of home dental

  You can clean your cat’s teeth with a   Or you can use a pet toothbrush.
76 Guide to a Healthy Cat

Other Ways to Keep Teeth Clean
Dry foods tend to cause less plaque buildup than canned foods, so feed-
ing some dry food can help the teeth. Feline diets that are formulated
to prevent plaque buildup are available and can be fed as a maintenance
diet or as a treat. Specific dental treats are also available, but none of
these products will knock the existing plaque off the teeth.

Do You Need to Take Your Cat to a Dentist?
Your regular veterinarian should be able to provide routine dental
examinations and care. Some veterinarians are able to perform restora-
tions and root canals. Some can even perform orthodontics! If veteri-
narians choose to pursue it, they can be board-certified in dentistry.
    During your cat’s annual physical exam, his teeth and gums should
be examined and evaluated.Your veterinarian should let you know the
condition of your cat’s teeth and if dentistry is needed. Each cat builds
up plaque at a different rate, but almost all cats need to have their teeth
professionally cleaned by the time they are four years old. How fre-
quently the animal will need the procedure repeated varies, but many
cats need their teeth cleaned every year. Cats with bad gums may even
need cleaning every six months.
    If your veterinarian tells you your cat needs “a dental,” she is usual-
ly talking about cleaning, polishing, treating with fluoride and remov-
ing any infected, eroded or broken teeth. These procedures are per-
formed with the cat under general anesthesia, but as an outpatient; the
cat comes to the clinic in the morning and goes home at the end of the
day.Your cat’s teeth are cleaned the same way yours are, but unfortu-
nately, cats are not willing to open up and say “ahhh.”
    When dentistry is performed properly, many precautions are taken.
You should discuss any fears that you have regarding the procedure with
your veterinarian. Age is not a valid reason to decline a dental proce-
dure for your cat. Bad teeth and infection are harder on the cat’s body
than dentistry and anesthesia.
    Even if your cat is eating well, it doesn’t mean his teeth don’t hurt.
Owners frequently tell me how fabulously their cat is doing post-
dentistry.They say they did not realize how uncomfortable their cat was
until after the procedure was performed.
                                                     Annual Health Care   77

Pulling Teeth
When significant damage to a tooth has occurred, your veterinarian
will likely recommend that it be extracted. Unlike in humans, it is very
difficult to save a cat’s damaged tooth with any type of filling material.
Extractions can be performed during the same anesthesia used for the
dental cleaning. A combination of hand tools and a power drill may be
used to properly extract a tooth.
     Cats do not have the same cosmetic need for teeth that we do, but
their teeth do play a role in picking up food and holding it in their
mouths. Owners naturally are very concerned about their cat’s ability to
eat if several teeth need to be removed, but believe it or not, even cats
without teeth can eat dry food once their gums have healed.They can
make a mess because food drops out of their mouths, but they are happy.

There are two types of parasites: internal parasites, such as gastrointesti-
nal worms, and external parasites, such as fleas. It is common for kittens
and cats who go outdoors to have parasites, but adult indoor-only cats
have little exposure to these bothersome creatures.

Intestinal Parasites
It is recommended that all kittens have their feces checked for worms.
During a fecal examination, the sample is examined for worm eggs and
protozoal parasites.The common intestinal parasites are:


   Eggs for roundworms, hookworms and whipworms can be found by
examining feces under a microscope. It is not common to see tapeworm
78 Guide to a Healthy Cat

eggs; you are more likely to see the worm segments.The segments look
like rice when they are fresh (you’ll see these crawling around under
your cat’s tail) and then like sesame seeds when they dry out (you’ll see
these in places where your cat has been sitting).
    Over-the-counter de-worming medications are available that can be
effective against some types of worms, but rarely are they effective against
tapeworms. If you choose to use a non-prescription de-worming med-
ication, read the label carefully to make sure you are treating for the
right worm and giving the appropriate dose. If you don’t know what
type of worms your cat has, a visit to the veterinarian is advised.
    Coccidia and giardia are protozoal parasites—one-celled organisms
that can be seen under a microscope. Both are common parasites, but
giardia is more difficult to find in a fecal examination.
    All gastrointestinal parasites can cause diarrhea, but this symptom
will not always be present. It is possible for your cat to have worms
without you knowing it. During a routine physical exam, a veterinari-
an should look under the cat’s tail to check for tapeworm segments. A
fecal exam should be performed on all kittens, and during an adult cat’s
annual visit, it is a good idea to have a fecal sample checked.
    Veterinarians can diagnose and treat intestinal parasites with medi-
cine that’s specific for the type of parasite your cat has. Some parasites
can be eliminated with one treatment, but others need successive days
of treatment or repeated treatment two weeks later. Parasites are not
present in every fecal sample, so if your veterinarian recommends
repeating a fecal check, she has a good reason.
    Worms are not deadly to a cat, but they make absorption of nutri-
ents less efficient and they can cause diarrhea. Small kittens with large
numbers of worms are affected the most, and their growth and condi-
tion can be impaired. Protozoal parasites are more dangerous than

                            PARASITES UNITED

    Fleas and tapeworms are two parasites that have a connection.
    Cats get tapeworms by ingesting fleas that are carrying tapeworm
    larvae. Cats who hunt can pick up tapeworms from eating rodents
    and rabbits carrying the parasites. Humans cannot get tapeworms
    from their cats; a human would have to either eat a flea to get the
    same tapeworms or ingest tapeworm eggs from the environment
    or in raw meat.
                                                      Annual Health Care   79

worms if uncontrolled, because they can cause dehydration and more
severe diarrhea.
    Cats do not carry pinworms. If you have a child with pinworms, do
not blame your cat; they came from another source. Humans, though,
can become infected with feline hookworms or roundworms.

Flee, Fleas!
Aside from causing discomfort to your cat, fleas can cause:

     •   Allergic dermatitis
     •   Anemia
     •   Tapeworms
     •   Discomfort to you and other pets

    Cats are very sensitive to many chemicals, so any time you use an
over-the-counter flea product, be sure to read the label and be careful.
Never use flea control products labeled for use with dogs. They can be deadly
to your cat. One common canine flea control chemical, called perme-
thrin, causes tremors, seizures and shock in cats. It is best to get profes-
sional advice regarding flea control, and your veterinarian and her staff
are a great resource.
    In the 1990s, there were great advances in products that are effec-
tive against fleas. Some of the safest and most effective products are only
available through veterinarians.Types of flea control products include:

     • Flea combs
     • Oral or injectable preparations or collars with insect growth
     • Spot-on adulticides
     • Shampoos
     • Dips
     • Sprays
     • Foams
     • Powders
     • Collars
     • Interior home treatments
     • Yard sprays
80 Guide to a Healthy Cat

     Program, Advantage, Revolution and Frontline are among the new
products that have revolutionized flea control. Program is administered
orally or by injection. The other three products are spot-ons, which
means you place them on the back of the cat’s neck. Although expen-
sive and available generally through veterinarians, they are very safe,
effective and work for up to a month.These products have made sham-
poos, dips, sprays, powders, collars and foams obsolete. Flea experts rec-
ommend using an insect growth regulator, such as Program, and an
adult flea killer, such as Advantage or Frontline, in combination to pre-
vent the emergence of resistant fleas.
     Cats who stay indoors generally have fewer problems with fleas
than cats who go outside. It is more difficult to control fleas if you have
several pets.These factors are all important in deciding which flea con-
trol products to use.The flea has historically developed resistance to all
products developed to eradicate it, so it will be interesting to see what
happens with the newer products available. Will fleas continue to beat
the system?
     Fleas like to live in warm, moist environments.They can live inside
all year round, and in warmer climates they can survive outside all year.
The best way to monitor a cat for fleas is to comb him regularly with
a flea comb.The comb will catch fleas in its teeth and also trap flea dirt
(little black spots that are actually digested blood). If you find signs of
fleas, continue to comb and try to pick them all off, or you can use the
comb as a gauge of your success with other products.

Other Parasites That Can Make Your Cat Itch
Cats can be infested with other external parasites, including mange,
mites and lice. Luckily, these feline-specific parasites are not usually
contagious to humans. More information on these parasites is included
in Chapter 15.Your veterinarian can make recommendations on rid-
ding your cat of these parasites.
Chapter 9

Tell Me About Vaccines

When you get a vaccine reminder card in the mail from your veteri-
narian, you probably think it looks like a game of Scrabble. What are
FRCP, FeLV and FIP? Many owners don’t ask about what these letters
stand for, and just tell the veterinarian to go ahead and give the cat all
the shots she needs. I don’t think this is a good idea.
    As a cat owner, it is useful to have some basic knowledge about the
diseases you protect your cat from with vaccines.You may be surprised
to find out that vaccines are not as protective as you have been led to
believe, and that annual vaccines may not be in your cat’s best interest.
The purpose of vaccinating is to “teach” the cat’s immune system to
fight specific infectious agents. Does the system need to be reminded
every year?

Antibodies obtained from their mothers protect newborn kittens from
many diseases. This maternal immunity decreases between 8 and 12
weeks of age, and the kitten then needs other protection. The purpose
of vaccinating is to “teach” the kitten’s immune system to fight specific

82 Guide to a Healthy Cat

infectious agents. In almost all cases, vaccinating at 8 and then again at
12 weeks of age is adequate.Vaccination at these times provides protec-
tive immunity to the disease agents in the vaccine.This immunity pro-
tects against most symptoms connected with the disease agents but may
not fully prevent infection. It can take up to 14 days after the vaccina-
tion for full immune function to develop. It is not known for sure how
long the protective immunity lasts after that.
    Annual vaccinations for cats have long been veterinary standard
practice, and owners have been taught to vaccinate their pets each year.
However, in the 1990s the veterinary profession began to question the
need for annual vaccinations. This comes in light of new information
regarding the duration of immunity derived from vaccines, and adverse
vaccine reactions, including tumors, that may be associated with sites of
    The vaccine manufacturers have recommended annual re-vaccination
based on studying the duration of immunity for a few weeks to months.
They have not been required by the USDA to determine longer durations
of immunity, except in the case of the rabies vaccine.Although rules have
changed for establishing minimums, maximum duration of immunity
studies are not required, so we do not know exactly how long a vaccine
will protect a cat.

                              HOW DISEASES
                               ARE SPREAD

    Infectious agents are viruses, bacteria and fungi—microorganisms
    capable of causing disease. Infectious agent exposure can occur by
    many routes. Each agent has its own way of passing between cats.
    Airborne infections are more likely to affect cats housed in board-
    ing facilities, catteries or shelters. Diseases that are spread by direct
    cat-to-cat exposure are more likely in cats who go outdoors, where
    uncontrolled contact between cats can occur.
       Introducing a new cat into your home also has the potential
    to introduce infectious agents.This is especially true if the cat has
    come from a cattery or shelter.To try to prevent problems, isolate
    a new addition to the household for at least one week and have
    her examined by a veterinarian before introducing her to your
    other cats.
                                                  Tell Me About Vaccines   83

In the mid 1990s the American Association of Feline Practitioners
(AAFP) took a bold step and created an advisory panel on feline vaccines.
They first published feline vaccination guidelines in January 1998 and
then revised them in 2000.These recommendations base vaccine admin-
istration on a cat’s individual risk factors, history and age.They question
the necessity of vaccinating every cat every year for every disease.
     The following information highlights some of the vaccination
guideline recommendations. Your veterinarian may or may not be
familiar with these specific guidelines, but discussing your individual
cat’s vaccination needs is important.
     The AAFP Feline Vaccination Guidelines state, “The objective of
feline vaccination protocols should be to vaccinate more cats in the
population, vaccinate individuals less frequently, and only for the dis-
eases for which there is a risk of exposure and disease.” Assessing an
individual cat’s risk of infection is a cornerstone in developing a vac-
cine protocol.The three items that need to be evaluated are the cat, the
cat’s environment and the infectious agents the cat may be exposed to.

Evaluating Risk
When making a decision about vaccination, risk factors to consider are:

     •   Age of the cat
     •   Number of cats in the household
     •   Exposure to outdoor or free-roaming cats
     •   Whether the cat will be at a boarding facility
     •   Where the cat lives (cattery, shelter or private home)
     •   Whether the cat is shown or routinely goes out for other
         types of activities

    Because they have immature immune systems, young kittens are
more susceptible to disease than adult cats. Initially, kittens are protect-
ed by antibodies they receive through their mother’s milk.The first milk
a queen produces is called colostrum, and it is rich in protective anti-
bodies. These antibodies provide maternal immunity and are absorbed
84 Guide to a Healthy Cat

into a kitten’s system during her first 24 hours of life. Maternal immu-
nity wears off by 12 weeks of age, and kittens must then develop anti-
bodies on their own.Antibodies are developed after vaccination or after
exposure to infectious diseases.
     The number of cats in the home and the chance of exposure to
other cats also play major roles in assessing risk.The chance of exposure
to infectious agents in a household with one or two cats is significant-
ly less than in a larger multicat household. Cats who go outdoors and
come in contact with free-roaming or other indoor/outdoor cats face
a higher risk of disease exposure.
     Cats who are housed in boarding facilities, catteries, or shelters have
a greater opportunity of being exposed to infectious agents.This is due
to stress, crowding, and simply the number of cats in the facility. Cats
who regularly go out to shows or on visits also are at greater risk.That’s
because cats who come from different environments can bring differ-
ent infectious agents with them.
     It can take up to 14 days post-vaccination for the full immune
response to develop. So if you vaccinate your cat for the first time today,
she will not have protective immunity until at least 14 days after the ini-
tial vaccine series has been completed.
     The decision to vaccinate against a particular infectious disease
agent should be based on reviewing the patient’s risk assessment.
Currently, vaccines exist to protect against 11 different infectious dis-
eases in cats, and several manufacturers produce vaccines.The infectious
diseases are:

     •   Rhinotracheitis virus (feline herpes)
     •   Calici virus
     •   Panleukopenia virus
     •   Chlamydia (pneumonitis)
     •   Feline leukemia virus
     •   Rabies virus
     •   Feline infectious peritonitis virus
     •   Bordetella
     •   Ringworm fungus
     •   Feline immunodeficiency virus
     •   Giardia
                                                   Tell Me About Vaccines   85

The AAFP guidelines have created two categories of vaccines: core and
non-core. A core vaccine is recommended for all cats.This recommen-
dation is based on several factors, including severity of the disease,
potential risk to humans, prevalence of the disease, and safety and effi-
cacy of the vaccine. A non-core vaccine may be appropriate in certain
situations, but is not recommended for all cats.
     The four vaccines that have been deemed “core” are the ones that
fight feline panleukopenia virus, feline rhinotracheitis virus (feline herpes),
feline calici virus and rabies virus.

Feline Rhinotracheitis, Calici and Panleukopenia
This vaccine is most commonly known as the FRCP or three-way vac-
cine.The general recommendations for this core vaccine are:

     1. Vaccinate kittens at their initial veterinary visit (at six to eight
     2. Vaccinate again every 3 to 4 weeks until the kitten is over 12
        weeks of age
     3. Give a booster one year later
     4. Booster every three years, unless the cat has a higher risk of
        exposure such as boarding or traveling to cat shows

    Feline panleukopenia (FPV, also sometimes called feline infectious
enteritis) is usually fatal to affected cats. It attacks white blood cells.The
virus is shed in feces and transmitted through fecal-oral contact.
Panleukopenia virus can contaminate cages, bowls and litter boxes and
be spread through poor hygiene. Most vaccines available against this
disease stimulate complete protective immunity. Clinical signs associated
with panleukopenia can include fever, anorexia (loss of appetite), vom-
iting and diarrhea. Death can be rapid due to severe dehydration and
electrolyte imbalances. The most characteristic finding is an extremely
low white blood cell count when a complete blood count is run.
    According to the AAFP report, there is some research to indicate
that immunity is sustained for at least seven years after vaccination.
However, the research is not definitive and the report recommends a
three-year interval for now.
86 Guide to a Healthy Cat

     Feline herpesvirus and feline calicivirus are estimated to cause up to
90 percent of upper respiratory disease in cats.These diseases are rarely
fatal but are extremely prevalent.Transmission occurs through sneezing
and is spread through the air, by direct contact and by touching con-
taminated objects. The most common signs are sneezing, anorexia and
conjunctivitis (inflammation of the tissues around the eyeball).
     Feline herpes virus (FHV-1) does not cause disease in humans.
(Humans can be affected with Herpes simplex, which causes fever
blisters, and Herpes zoster, which is responsible for chicken pox and
shingles.) Cats can develop chronic herpes virus infections that cause
long-term, intermittent bouts of sneezing and conjunctivitis. Feline calici
virus (FCV) infection can also cause limping or severe gum disease.
     Currently the most common form of vaccination is injectable, but
the FRCP vaccine is also available as a topical vaccine.Topical vaccines
may be administered intranasal (in the nose) or intraocular (in the eye).
The benefits of topical vaccinations are that they stimulate more rapid
protection and there is no chance of developing an injection site tumor.
This type of vaccine can be useful in boarding, cattery, and shelter sit-
uations when quicker and more frequent upper respiratory disease pro-
tection is needed.The disadvantages of topical vaccination are that they
can trigger mild sneezing, coughing and conjunctivitis.
     Vaccination against herpes and calici viruses does not prevent infec-
tion but does reduce the severity of the associated clinical signs. In addi-
tion, the calici virus vaccines that are currently available probably do
not protect against all forms of the virus.

Rabies is among the core vaccines because of the potential for a rabid cat
to bite and infect a human and because the disease is lethal to cats. Rabies
is transmitted primarily through bite wounds, and the virus is present in
the saliva of infected animals. Clinical signs associated with rabies infec-
tion are behavioral changes, pupil dilation changing to constriction,
drooling and stumbling. Normally friendly and affectionate animals can
suddenly and unexpectedly turn aggressive and agitated when infected
with rabies, and normally aloof cats can become very friendly. Infected
animals can die within four days of developing clinical signs. Once clin-
ical signs develop, there is no effective treatment for rabies.
     The incubation period of the virus—the time from bite wound to
clinical signs—varies. Rabies is introduced into a cat’s body by a bite,
spreads up nerves to enter the central nervous system, then spreads to other
body tissues. For some reason, the virus likes to go to the salivary glands.
                                                 Tell Me About Vaccines   87

    A few species of animals are more likely to carry rabies than others.
Always use caution if you come in contact with bats, skunks or rac-
coons (especially during the day, since these are normally nocturnal ani-
mals), because they are common carriers.These animals can carry rabies
but not develop clinical signs.
    The rabies vaccine can be administered to kittens over 12 weeks of
age, one year later and then every three years, according to the AAFP
recommendations. However, the frequency of vaccination may be
governed by state and local laws. Certain states require cats to be
vaccinated against rabies, while others do not. Each locale may also have
different rules regarding quarantine of animals who bite humans.
Healthy, nonvaccinated animals who bite humans may be under obser-
vational quarantine for 10 or more days.

The decision to vaccinate with one or more of the non-core vaccines
should be based on the previously discussed risk factors. Non-core vac-
cines are not necessary for all animals. They should be considered for
those cats who have a risk of exposure to the particular disease. You
should discuss the pros and cons of vaccination with your veterinarian.

Chlamydia felis is a bacterial infection that causes upper respiratory dis-
ease in cats.Transmission is through direct cat-to-cat contact.The most
common clinical sign is severe conjunctivitis.Vaccination does not pre-
vent infection with chlamydia, but it can lessen the associated clinical
    Don’t be alarmed when you hear about feline chlamydiosis caused
by Chlamydia felis. This is not the same agent that causes venereal dis-
ease in humans—that bacteria is Chlamydia trachomatis.
    The prevalence of Chlamydia felis in the United States is considered
to be low. Some veterinarians believe vaccines for chlamydiosis produce
a relatively high adverse reaction rate. Chlamydia is commonly the
fourth component of a four-way booster vaccine (FRCPC—Feline
rhinotracheitis, calici, panleukopenia and chlamydia), so be sure to ask
your veterinarian what she is giving your cat.
    The AAFP report says that because this upper respiratory disease is
not severe and most cats can be treated, and because the adverse events
associated with the use of the vaccine are relatively high, its routine use
is not recommended. At this time, the duration of immunity conferred
88 Guide to a Healthy Cat

by the vaccine is unknown, and annual vaccination is recommended
only for those animals who are at risk.

Feline Leukemia Virus
Feline leukemia virus (FeLV) is a potentially fatal virus of cats. It is
passed by direct cat-to-cat contact or by a queen to her kittens.Testing
and identifying FeLV-positive cats is essential to controlling infection.
Clinical signs associated with FeLV are nonspecific and can range from
anemia to immunosuppression to tumor formation. FeLV can cause
latent infections, which hide quietly in the cat but may cause clinical
signs months to years later.
    Vaccination is recommended for cats who test negative for FeLV
but live in environments where it is possible for them to be exposed to
the virus. Some veterinarians recommend that all kittens receive initial
vaccinations to FeLV because their exposure risk may not yet be
defined. For example, even though you do not want your kitten to go
outside, things might change and the animal could end up going out at
some point in the future.You would want her to be protected in this
situation. However, FeLV vaccine is not recommended for cats who
have little or no risk of being exposed to other infected cats.
    The vaccination schedule for FeLV is as follows:

    1. Vaccinate at nine weeks of age or older.
    2. Repeat vaccine four weeks later.
    3. If the cat remains in a high-risk environment, continue vacci-
       nating annually.

    Cats at risk for exposure to FeLV include cats who go outdoors,
stray cats, feral cats, open multicat households (new cats are often
brought into the home), FeLV-positive households and households
with unknown FeLV status.Vaccination confers fair to good immunity
in some cats, but this varies among vaccine manufacturers.The current
vaccines do not induce protection against the disease in all cats, so
preventing exposure to infected cats is still the best way to prevent
FeLV. FeLV vaccines have been associated with adverse reactions.They
are administered in the left rear leg muscle.

Feline Infectious Peritonitis
Feline infectious peritonitis (FIP) is a fatal virus of cats. The mode of
transmission is not definitively known, but the current theory is that it
                                                 Tell Me About Vaccines   89

is passed through oral or nasal contact with feces infected with feline
enteric corona virus (FECV), a common virus, which then mutates in
certain individuals to become FIP. A mutation is a change in the virus’s
genetic code.Transmission may also occur from a queen to her kittens.
    Circumstances that may influence whether or not FECV mutates to
FIP are:

     •   Age of cat (most susceptible cats are less than one year old)
     •   Breed of cat
     •   Genetics
     •   General health
     •   Immune status
     •   Environmental stresses

     On its own, FECV is not a life-threatening virus, but it can cause
diarrhea and is contagious among cats. In some catteries and multicat
households, every cat will have an antibody titer (which indicates
exposure) to a feline corona virus.This corona virus titer test does not
differentiate between FECV and FIP, so it is not a reliable screening
test.This, in turn, makes assessing protection from vaccination difficult.
The efficacy of the FIP vaccine has been controversial, because some
studies show that it offers some protection against the disease and oth-
ers fail to demonstrate significant protection. The AAFP report states
that since the vaccine has not yet been proven to be beneficial, it is not
recommended. Fortunately, the incidence of FIP in pet households
is low.
     The AAFP panel was unable to come to a consensus regarding what
constitutes an “at-risk” cat. One at-risk category would be cats in
households where FIP has previously been diagnosed, and vaccination
in that situation could protect cats who have not already been exposed.
     This vaccine is administered initially in two doses, three to four
weeks apart in cats over 16 weeks, and then boosters are given annual-
ly. FIP vaccine is only available in an intranasal form.

Bordetella bronchiseptica is a bacterium that is better known for causing
kennel cough in dogs. It has been cultured from cats with upper respi-
ratory infections and also in cases of pneumonia.Within the veterinary
community there is debate as to the necessity for this vaccine, because
90 Guide to a Healthy Cat

Bordetella does not seem to cause disease in many pet cats.The highest
incidences of Bordetella are in purebred catteries and in animal shelters.
Pet cats do not appear to be at a high risk for infection.
    In addition, the AAFP report states that the efficacy of this vaccine
has not been independently evaluated, and how often to revaccinate has
not yet been determined. Routine vaccination is not recommended,
but it is reasonable to consider vaccinating cats in environments where
the infection is present. Discuss this vaccine with your veterinarian.

A vaccine for Microsporum canis, one of the fungi that causes ringworm
(also known as dermatophytosis) is available. M. canis can affect both cats
and humans, but generally infections are limited to skin rashes.Although
ringworm is a somewhat common infection, most veterinarians feel that
the vaccine is not needed as a preventive. In addition, the AAFP report
states that vaccination has not been demonstrated to prevent infection or
to eliminate the disease-causing organisms from infected cats.
     A complete ringworm treatment program aimed at preventing and
eliminating the fungus can involve oral and topical treatment of the cat
and household premise treatment.The vaccine is probably most useful
as an addition to this program, when infections linger despite aggressive
     While the vaccine may decrease the visible lesions on the cat’s skin
caused by the fungus, it does not necessarily make a cat less contagious
to others.The duration of immunity conferred by the vaccine is ques-
tionable as well.

Feline Immunodeficiency Virus
This virus suppresses a cat’s immune system and makes him more sus-
ceptible to infections. Feline immunodeficiency virus (FIV) is most
often transmitted between cats through biting. Stray, intact male cats
who fight are the most common carriers. Casual, nonaggressive contact
is unlikely to spread infection.There is no cure for the virus, and most
infected cats live for years without showing any clinical signs.When cats
do become sick, it is due to the secondary infections their immune sys-
tems can no longer fight off.
    A vaccine to protect against FIV became available in the fall of
2002, but unfortunately it is not an ideal vaccine and at this time it is
not recommended for routine use.Vaccinated cats will test positive on
routine screening tests for FIV, thus making it impossible to distinguish
                                                 Tell Me About Vaccines   91

cats who have been vaccinated from cats who are actually sick.Also, the
vaccine does not protect against all of the common strains of FIV, so its
efficacy is questionable.
     If you have a cat who is at high risk for exposure to FIV, discuss the
vaccine with your veterinarian. High-risk pet cats are those who come
in contact with outdoor, free-roaming cats.

The vaccine against giardia, a protozoan parasite, was developed for use
with dogs but has also been used with cats.The efficacy of the vaccine
in cats is unknown. Giardia is most often passed via contaminated
water, but cats can also become infected by ingesting infective cysts in
the environment during grooming. This vaccine is not recommended
routinely. However, infected cats who were vaccinated had less severe
signs of the disease and were contagious for shorter periods of time, so
vaccination could be considered as adjunct therapy for resistant infec-
tions that are not responding to drug therapy.

What does all this mean? Well, your cat does need shots, and what shots
she needs should be based on a thorough risk assessment that you and
your veterinarian do together. One year after the initial vaccine series
has been completed, the cat should receive booster vaccines.Vaccination
in subsequent years should be based on the cat’s risk of exposure and
individual lifestyle.
    My vaccine recommendations for kittens are:

     • Feline rhinotracheitis, calici, panleukopenia (FRCP) at 8 and
       12 weeks
     • Feline leukemia (FeLV) at 10 and 14 weeks
     • Rabies if required by law, or if the cat goes outside at 12 to 16

    My vaccine recommendations for adult cats are:

     • FRCP annually to every three years
     • FeLV annually if the cat has a risk of exposure to outside cats
     • Rabies every three years if required by law, or if the cat goes
92 Guide to a Healthy Cat

The AAFP has standardized vaccine administration sites to help identi-
fy causes of local adverse reactions, and to aid in the treatment of
vaccine-associated sarcomas. Abbreviated, FRCP vaccines should be
administered over the right shoulder, FeLV in the left rear, and rabies in
the right rear; all should be administered as far down the leg as practi-
cal. If a veterinarian has given different vaccines in different sites, then
it’s clear which vaccine caused the problem.
     Adverse responses to vaccination do occur. Common reactions that
go away on their own include pain or swelling at the injection site. If
any type of lump, bump or swelling occurs in an area where you think
a cat may have been vaccinated, you should have it examined by your
veterinarian. It is not uncommon for a temporary reaction to occur, but
if it lasts for more than a month, it should be evaluated by cytology (a
microscopic examination of cells to determine the cause of a disease)
and/or biopsy (removing tissue for microscopic examination and diag-
nosis).You should consult with your veterinarian if any type of reaction
occurs after your cat receives a vaccination.
     Allergic reactions can occur in some cats after they have been vac-
cinated. These reactions can range from mild to severe anaphylaxis
(potentially fatal allergic reaction). If your cat has previously had any
type of allergic reaction, you should alert your veterinarian and discuss
possible preventive measures.These could include splitting up multiple
vaccines so the cat has just one vaccine at a time, medicating with an
antihistamine and/or a corticosteroid before the cat gets the vaccine, or
even discontinuing certain vaccines.
     If your cat has an allergic reaction or vomiting and lethargy
after vaccination, discuss splitting up the combination vaccines into
individual vaccines that are given at different times. The AAFP report
discourages the use of polyvalent vaccines (a single shot that contains
the vaccine of more than one illness), other than combinations of FPV,
FHV-1 and FCV, because using combination vaccines may force doc-
tors to administer vaccines that a cat does not need. In addition, as the
number of agents in a single vaccine increases, so does the possibility of
adverse vaccine reactions.Your veterinarian may even be able to split up
the FPV, FHV-1 and FCV vaccines into single doses that your cat can
receive at different times if she is particularly sensitive. These vaccines
must be ordered specially, but they are available.
     Another possibility is discontinuing vaccination altogether. The
purpose of vaccines is to help protect your cat, not make her sick.
                                                   Tell Me About Vaccines   93

Have Vaccines Been Linked to Cancer?
An increasing incidence of a type of tumor called fibrosarcoma has been
noted in locations on the body where vaccines are routinely adminis-
tered to cats. Research is being conducted and a national veterinary task
force exists to determine the relationship between vaccines and
fibrosarcomas. The incidence of vaccine site fibrosarcomas is estimated
at one to three out of every 10,000 vaccines administered, which is an
extremely low number.
     The general consensus in the veterinary community is that the risk
of disease from not vaccinating is much higher than the risks associat-
ed with vaccinating, but a rethinking of how, when, where and why we
vaccinate cats has resulted. This is an extremely controversial issue for
veterinarians, and not all veterinarians are in agreement over which
vaccine protocols should be followed.
     The information obtained so far from past and current research has
failed to pinpoint a specific cause of fibrosarcomas in cats. Initially it was
thought that aluminum adjuvants (chemicals added to a vaccine to
enhance its effectiveness), were responsible for tumors, and many cases
seemed to be linked to adjuvanted FeLV and rabies vaccines. Further
study showed that this is not necessarily true and that many types of
vaccines and other injectable products resulted in tumors in some cats.
Even vaccines that use newer recombinant DNA technology, touted as
unlikely to produce tumors, have been linked to tumors.
     At this time the consensus is that the genetics of the individual cat
may be the most important factor in whether a cat develops vaccine-
associated sarcoma. Certain cats may carry genes that predispose them
to form tumors at sites of inflammation.Vaccines and other drugs cre-
ate various levels of inflammation where they are injected. Research is
ongoing, and should eventually find the answer.
Chapter 10

Common Surgical

There are a few elective surgeries that you will consider during the first
year of your cat’s life.These are routine procedures that are performed
at a veterinary clinic. Any surgical procedure involves some risks and
anesthesia, but experienced veterinarians and modern drugs decrease
the potential for problems.
    Many cat owners look for deals on the price for these procedures,
and prices can vary greatly. Keep in mind that to use good anesthesia
and other drugs, monitor the patient adequately and perform the pro-
cedure in a sterile and painstaking manner does involve expense.When
prices are low, corners need to be cut somewhere.

In veterinary medicine, declawing cats is a controversial issue. Declawing
is a surgical procedure that permanently removes the last joint of each
toe, including the claw. Scratching is a normal cat behavior, and some

                                             Common Surgical Procedures   95

people feel that it is cruel and inhumane to remove a cat’s body parts
just because it makes the owner’s life easier.
    Many owners routinely have kittens declawed to prevent problems
later, when the cat may use prized household possessions as scratching
posts. Not every cat engages in destructive scratching though, and most
cats can be trained to scratch in an appropriate spot.
    In Britain it is illegal to declaw a cat.The British have stricter laws
than Americans do regulating cosmetic and surgical procedures being
performed on animals.

What’s Involved in Declawing?
When a cat is declawed, the last joint on each toe is amputated. Many peo-
ple think declawing involves cutting the nail very short or just removing
the nail the way we might have a toenail removed, but it actually requires
removal of bones. That means the cat’s paw pads must be cut open, the
joints severed and the pads reclosed.There are a few different surgical tech-
niques to do this, and each veterinarian has his or her preference.
    Most of the time, only the front claws are removed during a declaw
procedure, but in some situations owners ask that all four feet be done.
No matter which surgical technique is used, there is some pain involved
with declawing. If an owner wants to declaw a cat, I urge them to do
so at a young age (between 8 and 16 weeks).The pain associated with
the procedure is much less in smaller, younger animals.
    Injectable and/or inhalant anesthesia is required for the surgery.The
recovery period varies and depends on the size and age of the cat. It
also depends on the use of pain relievers and the occurrence of any
    Some veterinary clinics use a laser, rather than a scalpel blade, to
declaw cats. Lasers cut and cauterize tissue at the same time, so healing
may be faster. Laser procedures are significantly more expensive because
of the cost of the equipment used. There are other variations in tech-
niques. Some veterinarians stitch up the toes after the bones are removed,
some apply sterile surgical glue and others just bandage the foot.
    After a cat has had declaw surgery, the paws may be wrapped, and
the animal may be hospitalized for one or two nights. Using shredded or
pelleted newspaper litter for the first few days after surgery helps to keep
small particles (from clay or clumping litter) out of the surgery sites.
96 Guide to a Healthy Cat

    Veterinarians can use pain-relieving drugs to help with discomfort
after surgery. Oral pain relievers can be prescribed, but the application
of a patch that continuously releases small amounts of a painkiller is
becoming more and more popular. Ask your veterinarian about post-
operative pain relief if you declaw your cat.

Is Declawing Cruel?
There are different opinions regarding declawing. I personally think it is
a painful procedure, and before declawing your cat, you should try to
train him to use a scratching post. If a cat is being destructive or injur-
ing you with his claws, and you have bought the cat a suitable scratch-
ing post (tall enough, sturdy enough, of a suitable material) and placed it
in a spot where your cat likes to scratch, and a serious attempt at train-
ing is not successful, and you are going to keep the cat inside, declawing
may be a valid alternative. It should not be done routinely without a sin-
cere attempt to first train the cat to redirect his natural instincts.
    Many humane groups and the Cat Fancier’s Association condemn
declawing, but it is a personal choice for each cat owner. Some breed-
ers and cat rescue groups will require you to sign a contract stating that
you will not declaw any cat you buy or adopt from them.
    During the recovery period it is common for cats to be hesitant to
jump, and they may hold their paws up in the air when sitting. These
signs indicate the cat is in pain. Owners are frequently concerned after
the surgery when their cats show these signs, but they need to under-
stand that it takes time for healing and calluses to form around the
newly exposed bones and nerve endings.

Declawing Alternatives
The most basic alternatives to declaw surgery are trimming a cat’s nails
every few weeks and training the animal to use a scratching post.
    Vinyl nail caps, called Soft Paws, are available. They cover the cat’s
normal nail with a smooth cap, thus preventing nails from causing dam-
age, and last about a month. Many veterinarians carry this product and
will apply the caps for you.Take-home kits are available if you want to
apply them yourself.
    Digital flexor tenectomy is an alternative surgical procedure, but
not one that I favor because I don’t think there are enough benefits.
Instead of amputating the bone in the toe, a small piece of the tendon
                                              Common Surgical Procedures   97

that controls claw movement is removed. It prevents the cat from pro-
truding or retracting her claws, and it is a less painful procedure since
no bone is removed. When this procedure is performed, the cat’s toe-
nails still need to be trimmed regularly because the animal cannot con-
trol them and the nails will not wear down.

Side Effects of Declawing
It is rare for physical complications to arise from declawing, but it is
always a possibility. Infections are not common, and they do respond
favorably to antibiotic treatment. Swelling of the paws can occur and is
controlled with bandaging. If a veterinarian uses careless surgical tech-
niques, a toenail or part of a nail can regrow. Noticeable regrowth may
not be apparent for years following surgery, but presents as swollen toes
with areas that drain fluid, or have pieces of nail sticking out.
     Studies show that declawed cats do not bite any more than clawed
cats. Declawing does not directly change a cat’s behavior, either. Declawed
cats can still climb (but not as well), but their ability to defend themselves
is curtailed, so they should not be allowed outside unsupervised.

Part of being a responsible owner is sterilizing your cat, whether the cat
is male or female. Men who own cats are sometimes empathetic about
their male cat and do not want to castrate him, but this is ridiculous. Cats
have sex to reproduce, not because they derive any pleasure from it.
    Neutered cats live happier, healthier lives and make much better pets
than intact animals. If you have ever smelled the urine of a tomcat, you
will understand why you would not want one in your home. Once tom-
cat urine soils something, the odor cannot be removed. It is even hard to
deal with the smell of tomcat urine after a litter box has been emptied!

                               HIGHER RISK

    Two deadly viruses, feline leukemia virus and feline immunodefi-
    ciency virus, are much more common in intact male cats.This is
    because the viruses are passed by direct contact, especially through
    biting—and biting and fighting occur most often between two
    male cats. Neutering can help prevent the spread of these diseases.
98 Guide to a Healthy Cat

What Is Neutering?
When a male cat is neutered, both testicles are surgically removed. In
doing so, the main testosterone-producing organs are taken out of the
body.Testosterone is responsible for:

     •   The terrible odor of tomcat urine
     •   Wide facial jowls
     •   Thicker skin
     •   Increased territoriality
     •   Marking territory by spraying
     •   Aggressive tendencies, including fighting between male cats
     •   The tendency to roam farther from home
     •   Stud tail, a greasy spot at the base of the tail

     All of these problems are eliminated or at least decreased by neu-
tering.A male can no longer produce sperm without testosterone, so he
is infertile, as well. And the cat has no chance of developing testicular
cancer and a much lower chance of developing prostate problems.

Will Neutering Change Your Cat’s Personality?
Neutering does not change any of the good aspects of a cat’s personal-
ity. It can take the aggressive edge off an animal, but an affectionate male
will love you (perhaps even more) after being neutered. The evening
after surgery your cat could still be feeling the effects of anesthesia and
may act differently, but that wears off on its own by the next day.
      The beneficial effects of neutering are not seen immediately, and if
you neuter a kitten who has not reached puberty, you will not see any
changes. Neutering a young animal prevents behavioral and odor prob-
lems. If you neuter a cat who has reached puberty, it will take a few
weeks for behaviors and odors to change as the testosterone level
      Owners sometimes ask me whether their cat could have a vasecto-
my instead of castration. Although one of the purposes of neutering is
to prevent reproduction, the main reasons are to decrease the undesir-
able behaviors associated with testosterone. If a cat had a vasectomy,
testosterone would still be present and so would the associated undesir-
able behaviors.
                                              Common Surgical Procedures   99

When Should You Neuter?
The general recommendation for neutering a cat is at six months of age.
This is before an average cat reaches puberty. Many humane groups and
breeders will neuter kittens, if they have two testicles in their scrotums, at
eight weeks of age, to ensure that the cats never mate.This early-age neu-
tering is considered safe, and it does not cause problems later on in life.
    Most veterinarians neuter cats as an outpatient procedure:The ani-
mal will come in the morning, have surgery and then go home the
same evening. Neutering is a surgical procedure usually performed
under injectable anesthesia and does not require stitches.There is little
aftercare, and a post-surgical visit is not needed.

Cats With Only One Testicle
All male cats have two testicles, so if they are not in the scrotum, they
are somewhere else. During normal development, the testicles move
from inside the abdominal cavity to outside into the scrotum.When this
does not occur, the testicles are considered retained. Most male kittens
are born with testicles in their scrotums. If testicles are still retained at
eight months of age, it is unlikely they are going to descend.
     Cryptorchid is the term used to describe a cat with only one testicle
present in the scrotum.The term monorchid may also be used. If a male
cat has neither testicle in the scrotum, he is called a bilateral cryptorchid.
     Retained testicles still produce testosterone, but cryptorchid cats are
less fertile than normal cats. Because testosterone is present, these ani-
mals should definitely be neutered. Cryptorchidism is heritable, and
animals with this trait should not be bred.
     The surgical procedure for a cryptorchid cat is similar to a spay
(described in the next section). The retained testicle is either going to
be in the abdominal cavity or somewhere along the path through
which it would normally descend, such as the inguinal canal.This pro-
cedure costs more than an uncomplicated neuter, because the surgery
needed to find the testicle takes longer and is more complex.

Cats are very efficient at reproducing, and once a female feline has reached
puberty, she is sexually mature and can reproduce. Female cats usually
reach puberty around six months of age, but during the spring mating
season and in multicat households, puberty occasionally comes earlier.
100 Guide to a Healthy Cat

    Female cats exhibit some bizarre behaviors when they go into heat.
Most cats get very friendly, rub up against you and other animals in the
family and stick their rear ends up in the air. During a heat cycle they
may howl and writhe on the floor, even looking as if they are in pain.
Cats do not bleed when they are in heat. At my veterinary clinic we
frequently get calls from new cat owners who are in a panic after
observing these behaviors in their cat.
    Cats are seasonally polyestrus.Their heat season generally runs from
February to September, and females can have a heat cycle every two
weeks during this time unless they are bred or stimulated to ovulate.
This explains how cats can produce a new litter of kittens every few

What Is Spaying?
The technical term for a spay is ovariohysterectomy, which means surgi-
cal removal of the uterus and ovaries. Most veterinarians perform ovar-
iohysterectomy surgery with the cat as an outpatient. Although this is a
routine procedure, people often do not realize that an abdominal sur-
gery is being performed. The cat is placed under general anesthesia,
usually with some type of gas anesthetic, and an abdominal incision is
made. The ovaries and the uterus are removed, and the surgery site is
closed with stitches.The stitches may be absorbable or you may have to
return to have them removed in 10 days, depending on the preference
of the doctor.

When to Spay
If possible, you want to spay a cat before she goes through even one
heat cycle.This can be achieved by spaying at six months of age.As with
male kittens, early-age sterilization is possible as young as eight weeks
of age.There are no benefits to having a cat experience a heat cycle, and
certainly there is no benefit for a cat to have a litter of kittens.These are
    Meanwhile, there are benefits to spaying a cat before her first heat
cycle. Female cats who have experienced one or more heat cycles are
more likely to develop malignant breast cancer than spayed cats.
Spaying before six months also spares her (and you!) the difficult expe-
rience of a heat cycle. In addition to the behavioral changes I’ve already
mentioned, cats in heat may groom excessively, experience loss of
appetite, and may also urinate outside the litter box.
                                             Common Surgical Procedures    101

The Benefits of Spaying
Aside from stopping annoying heat cycles, spaying will prevent your cat
from contributing to pet overpopulation. Each year tens of thousands of
cats are put to death in the United States because no one wants them.
     Intact female cats are at risk for pyometra—a life-threatening uter-
ine infection. An infection like this cannot occur if there is no uterus.
     Spayed female cats are less likely to roam in search of a mate, and
they are less likely to be aggressive.As with male cats, sterilizing will not
change any of the positive aspects of the animal’s personality.
     There are always some slight risks involved with surgery and
general anesthesia, but for a young, healthy cat they are negligible. If
complications were to occur, they would most likely be due to an
underlying health or congenital problem or poor surgical techniques.
This is another reason why you should think about factors other than
cost when choosing a doctor to perform the surgery.
     An ovariohysterectomy is an irreversible procedure, so once a cat is
spayed she will never be able to reproduce. Some cat owners want to
experience the birth of kittens, especially if they also have children.
Instead, I think they should visit their local animal shelter and see what
happens after the miracle of birth when homes are not found for the
     On occasion, the owner of a purebred kitten tells me that he wants
the cat to have kittens so that he can recoup what he spent to buy the
cat. I think this is a terrible reason to breed a cat. Responsible breeders
sell purebred kittens as pets because they are not up to show quality.
They want you to sign a contract that you will not breed the animal.
You should buy a pet purebred cat because you want a cat of that breed,
not because you want to make money. If any complications arise dur-
ing the pregnancy and measures such as a caesarian section are needed,
the litter will end up costing you a lot of money.

Some kittens are born with hernias, which are holes in a muscle that
should normally be solid.These defects are usually not very serious and
can be corrected with a simple surgical procedure.
     The most common type of hernia is an umbilical hernia. It occurs
when the kitten’s belly button does not close properly after birth. The
hole that is left is usually quite small and it appears as an out-pocketing
at the middle of the belly, covered by skin. If you touch it, it feels soft.You
102 Guide to a Healthy Cat

can even reduce the hernia temporarily by gently pushing the abdomi-
nal fat back into the small hole in the body wall with your finger.
     Umbilical hernias are not an emergency, and they can be repaired
when the animal is sterilized. Repairing an umbilical hernia involves
putting a few stitches in the abdominal wall and the skin. A spay inci-
sion can usually be extended to include and then close an umbilical
hernia. In a male cat, a hernia repair will be at a different site than the
castration surgery. If your cat has an umbilical hernia, ask your veteri-
narian about repairing it at the time of sterilization.
     Another type, called an inguinal hernia, appears as an out-pocketing
in the groin region. Abdominal fat or organs can push out of this hole
in the abdominal wall. Inguinal hernias can be a congenital defect (one
a cat is born with) or they can occur as a result of a physical trauma.
Inguinal hernias are usually not emergencies, but because they can
enlarge, they should be repaired.
     Two other hernias are occasionally found in cats.These are diaphrag-
matic and pericardial-diaphragmatic hernias.These types of hernias occur in the
chest cavity and are diagnosed with an X ray.You might suspect one of
these in an animal who is having some difficulty breathing. Breathing is
affected because abdominal organs that would normally be held back by
an intact diaphragm (the muscular band separating the chest and abdom-
inal cavities) are able to move into the chest cavity and compress the lungs.
     Diaphragmatic hernias are most often due to trauma. The muscle
tears away from the body wall.This injury needs to be surgically repaired.
Diaphragmatic hernias should be repaired as soon as it is safely possible.
     The risk with any hernia is that if it gets larger, organs can get
trapped in abnormal locations and be damaged. It is rare for an umbil-
ical hernia to get larger, and if surgery is not performed, it could sim-
ply close by developing scar tissue with a bubble of fat protruding, or it
could stay open throughout a cat’s life and continue to feel like a soft
out-pocketing. The risk with a diaphragmatic hernia is severe impair-
ment of breathing.
     Pericardial-diaphragmatic hernias are congenital defects. In this
condition, the diaphragm is connected to the pericardium, which is the
sack surrounding the heart. This malady sounds serious and looks ter-
rible on an X ray, but the surgical repair can be more dangerous than
living with the defect.
     A pericardial-diaphragmatic hernia should be left alone unless it
affects the animal’s ability to breathe or compromises digestive func-
tions. Some kittens born with this defect never show signs, because
their bodies slowly compensate as they grow.
Chapter 11

Pregnancy and Queening

Cats are very efficient at reproducing and are able to have several litters
a year with multiple kittens in each. Most cats go through puberty at
an early age—somewhere between five and nine months. Females can
be fertile for about seven years, while males may be able to reproduce
for 11 years or more.
    The large numbers of feral cats (cats who have returned to a wild
existence) demonstrate that in an uncontrolled environment, cats will
keep reproducing.Today’s methods of sterilization are surgical and thus
are not easily applied to the vast numbers of feral cats. Researchers are
working on new methods of feline contraception, including oral med-
ications and even vaccines. These methods will help stop kitty over-
population in the future.

Most females reach puberty around six months of age and cycle every
two weeks until they are bred or induced to ovulate.The cycle begins
with proestrus, which lasts one to three days. This is the stage when
female cats start showing they are ready to mate, but they will not yet

104 Guide to a Healthy Cat

allow males to mount them. Restlessness, increased vocalization, facial
rubbing and rolling are the not-so-subtle female signals.
     Estrus is the period of sexual receptivity that follows.The behaviors
that began in proestrus become more apparent, plus the female will now
permit copulation. If there are no tomcats and therefore no mating,
estrus lasts about 10 to 14 days, then the cat gets a break for 2 to 3 weeks,
then estrus returns. Repeated estrus can be annoying for owners, because
there is nothing that can be done to calm the cat’s behaviors. It is also
stressful for the cat, who cannot control her urges to find a mate. Cats
have been known to lose their appetite and sleep poorly during estrus.
     When a female cat is in estrus, she does not bleed like a dog; rather,
she has changes in behavior.The changes can include:

     •   Increased vocalization
     •   Rolling on the ground and crying
     •   Lying on her belly with her rear end pushed up in the air
     •   Acting more affectionate
     •   Attempting to escape the house and get outside
     •   Urinating outside the litter box, often on vertical surfaces

    Metestrus occurs the day after estrus ends. During this time females
aggressively reject male approaches. Pregnancy follows if fertilization
occurred during mating.
    Anestrus is the quiet part of the estrous cycle. It occurs between
periods of estrus and during the late fall, when the seasonally polyestrus
cat does not cycle.

Male cats have the ability to be continually sexually active once they
have reached puberty. Females, however, are only sexually active when
they go through their heat cycles.
    Female cats will only accept a male mounting them and copulating
when they are in heat (estrus). If a female is not in heat, she will not
stand still for a male. If she is in heat, she will allow a male to mount
her, then, after intromission occurs, she will bite and strike at him to
leave her alone.
    Female cats are induced ovulators, which means the act of copulation
stimulates them to release their eggs.They can ovulate more than one egg
during each breeding and can be quite unparticular about their partners,
                                                 Pregnancy and Queening   105

allowing several males to mount them during estrus.This makes it possi-
ble for different males to sire different kittens in the same litter. A female
may allow four or more breedings (with the same or different males) to
occur during a few days of a heat cycle. Intact tomcats are ready to do their
duty at all times, but they are not the decision makers.They may attempt
to mount females who are not in heat, but they will be rebuffed.As a dom-
inant behavior, some male cats even try to mount other male cats.
    An average healthy male is usually fertile. Problems with male
reproduction may be caused by:

     •   Lack of libido
     •   Low sperm counts
     •   Hair caught around the penis
     •   Cryptorchidism
     •   Lack of coordination

     If someone is trying to breed a male cat, they will most likely put
him with an experienced female for the first attempt. Often when two
kitty virgins are put together, neither knows what to do and the male
can get frustrated and lose interest if he is not successful.
     Most professional cat breeders keep one or two intact males in their
catteries with four or more females. Keeping a tomcat can be a smelly
experience, and because one male can breed with several queens
(unspayed female cats), fewer males are needed to have a good breed-
ing program.
     The entire mating process of cats can last a few short minutes and
can be repeated several times within a day. Cats do not care who their
partners are, and the female could care less about the male after he has
done his duty.
     If you have ever observed cats mating, you’ve likely noticed that it
is a rough activity.The tom will mount the female and bite her on the
back of the neck.After intromission, the queen will scream, turn around
and bite the male until he releases her.

If she’s in heat and given the opportunity to be with an intact male,
chances are a female cat will get pregnant. The average cat’s gestation
period is 63 to 65 days. There are many physical changes a female cat
will experience during a pregnancy.
106 Guide to a Healthy Cat

    The tom takes no role in raising his kittens, and some toms are even
aggressive toward kittens. On the other hand, a queen will be very pro-
tective of her babies.
    You may remember Scarlet, the mother cat who made headlines in
1996. Scarlet entered a burning building five times to save her five kit-
tens, although she was severely burned in the process.A mother cat will
also protect her kittens from you. If you are caring for a feral queen, be
careful of how much you handle her kittens, because she may reject
them. She may also become aggressive with you if you try to handle
them in her presence.

Signs of Pregnancy
An inexperienced cat owner may be unaware of the signs of heat. Some
cats put on more of a show than others. If you have a cat who has come
in and out of heat and suddenly seems to stop cycling, she’s probably
     Cats do not need much special care to maintain a pregnancy.They
seem to do fine on their own. Other than allowing a queen to eat what
she wants and protecting her from illness and parasites, you can leave
the rest to her.
     Because cats are only pregnant for about nine weeks, things happen
fairly quickly.The progression of signs is:

    1.   Increased appetite and weight gain
    2.   “Pinking up” of the nipples within two weeks of being bred
    3.   More rounded appearance of the abdomen
    4.   Engorgement of the mammary glands

     A veterinarian can palpate a female cat’s abdomen and confirm a
pregnancy three to four weeks into gestation.The fetuses develop bones
at about 54 days, so an X ray at this time can tell how many kittens will
be born. An average litter contains three to five kittens, but in reality,
litter size can vary a lot. X rays do not damage the fetuses, and they can
be useful if you want to know what to expect. Ultrasound is useful for
confirming pregnancy as early as two to three weeks, but it is not reli-
able for determining the number of fetuses.

Can You Terminate Your Cat’s Pregnancy?
Purebred cat breeders know when their females are cycling and try to
plan their pregnancies. Ideally, they mate cats who are not too closely
                                               Pregnancy and Queening   107

related and try to produce offspring who are healthy and have certain
characteristic traits. Owners of pet cats may want their female to have
a litter, and they have the right to do so—although again, I suggest that
they visit their local animal shelter first and see what happens when
there are too many kittens and not enough good homes.
     Sometimes time just gets away from a cat owner, and his cat is in
heat and pregnant before he’s had a chance to have the animal steril-
ized.What are the options?

Pregnant cats can be safely spayed, but most veterinarians do not like
performing the surgery when a cat is close to full term. If you know
your cat is in heat and that she got outside, she can be spayed before
significant fetal development has occurred.
    If you are already noticing that the cat’s belly is distended and she
looks pregnant, chances are the cat is at least six weeks pregnant. The
risks of spaying a pregnant cat are slightly higher than performing the
surgery on cat who isn’t pregnant, due largely to blood loss and
increased surgery time. However, if you do not want kittens, spaying at
this time should be considered.

Medical Intervention
Currently there are no safe and reliable medications that will terminate a
feline pregnancy, and if your queen is bred by an undesirable male, you
are out of luck. Drugs are available that will cause the pregnancy to abort,
but they can also harm the queen. For the safety of the queen, let her have
the kittens if you are set on breeding her again; otherwise, spay her.

Kitty Birth Control
Veterinarians do not prescribe birth control medications for cats
because of the risks they carry.There is one drug, however, that is occa-
sionally used by breeders to suppress a female’s heat cycle. Called
megesterol acetate, it is a synthetic hormone.
    Because most hormones have multiple functions, there are possible
side effects to any hormone treatment. Cats who receive even small
doses of megesterol acetate run the risks of:

     • Developing diabetes mellitus
     • Developing pyometra, a uterine infection
108 Guide to a Healthy Cat

     •   Mammary gland enlargement
     •   Developing mammary cysts
     •   Mammary cancer
     •   Decreased fertility

You can expect that a queen will soon be delivering when she shows
interest in creating a nest for the kittens to be born. You can express
milk from her mammary glands a day or two before she delivers.
    You can monitor a queen’s rectal temperature twice daily if you are
not sure when she will deliver. Twenty-four hours before delivery, the
body temperature of most queens drops to about 99°F.

What Happens During Labor?
The length of a queen’s labor depends on whether she has had kittens
before and how many kittens she is having. The period from the start
of contractions to the end of labor can be minutes, hours or even a day
if several breedings were responsible for the litter.
     You may observe a mucus plug being passed when a cat begins
labor. Contractions will follow and kittens will be born.The queen will
lick and remove the sac from the kitten; if she does not, the kitten can
suffocate and you need to intervene. The queen will then bite off the
umbilical cord that connects the kitten to the placenta.
     When kittens are born, they weigh only a few ounces and are
extremely fragile.They are very dependent upon their mother for sur-
vival because their eyes are closed, their ears are not completely devel-
oped and they can only crawl.
     The queen may continue her labor and produce more kittens. She
will continue to lick and clean the kittens that have been born and gen-
tly nudge them toward her nipples so that they can begin nursing.
Kittens are able to nurse within an hour of being born.
     Kittens receive their initial immunity to disease by absorbing anti-
bodies present in their mother’s colostrum. Kittens are only able to
absorb the antibodies in colostrum during their first 24 hours of life. It
is therefore very important for kittens to nurse from their mothers as
soon after birth as possible.
     The queen may eat the placentas, and as unappetizing as this looks,
it is very normal. She may have a vaginal discharge for up to two weeks
                                                 Pregnancy and Queening      109

                           RESPONDING TO A
                            DIFFICULT LABOR

    Just like humans, cats can experience problems with delivery.
    Dystocia is the term used to describe difficulty during the birthing
    process. A cat who has a prolonged, nonproductive labor, has gone
    67 days without going into labor or has a kitten stuck and protrud-
    ing from the vulva would be considered in dystocia. A weak or sick
    queen, a kitten turned backwards in the birth canal, a kitten who is
    too large to pass through the birth canal and a dead kitten in the
    uterus holding the others back are all causes of dystocia.
       If a queen is having contractions for an hour without producing
    any kittens, seek veterinary help. A veterinarian will take an X ray
    to see where the kittens are and to see if there are any abnormali-
    ties. He will also check the queen’s blood to see if she is having any
    problems, such as low calcium or low blood sugar, which would
    prevent her from having normal contractions. If ultrasound is avail-
    able, this test can check for fetal heartbeats and distress.
       A doctor may induce the queen’s labor with drugs or even con-
    sider performing a caesarian section, depending on the situation. If
    there are no apparent problems, the first step is to induce labor. If
    induction is not successful, a caesarian section is necessary.When
    surgery is performed, there is increased risk that the kittens will
    not survive.

after giving birth. The discharge might look like blood or might even
be green and mucoid, but it should not look like pus. If it looks like
pus, consult your veterinarian.
    If you have a queen who likes to roam, try to confine her in a room
with her kittens so that they aren’t neglected. Also be careful about flea
control. If a queen has fleas, they can jump to the kittens and cause life-
threatening anemia.

Examining Newborns
Unfortunately, kittens can be stillborn. If a kitten is not crying and wig-
gling after the placenta has been removed, pick her up and try to see if
she is alive. You can gently shake her upside down to try to clear any
mucus from her mouth and throat. Touch the chest to check for a
heartbeat. Check for jaw and muscle tone by opening the mouth and
moving the limbs, and if all feels limp, the kitten is probably not alive.
110 Guide to a Healthy Cat

    Within a few hours after the kittens are born, you should look them
over for any apparent birth defects or you can take them to your vet-
erinarian for an assessment.Things to check:

      1. Open the mouth and look for a hole in the roof of the
         mouth.This is called a cleft palate.
      2. Check to see that there are four legs and a tail.
      3. Check the umbilical area and make sure a hole is not present
         at the abdominal wall.
      4. Check under the tail and see if there is a rectum and a set of

   Kittens who are unhealthy at birth generally do not survive. Queens
may abandon or cannibalize kittens who are not healthy.

Mother nature knows best, and kittens who are cared for by their
mothers have a better chance of survival than orphan kittens who are
raised by humans. If you find kittens who have been abandoned by their
mother or have kittens who are not being cared for by their mother, be
prepared for a lot of work and possible disappointment. But if all goes
well, there are few more rewarding experiences than raising an orphan
kitten into a healthy cat.

                                                Feed Me
                                                Newborn kittens need to eat
                                                every two to three hours. They
                                                have very small stomachs and
                                                require small amounts of food
                                                regularly. Do not give cow’s
                                                milk to a kitten, because it will
                                                cause diarrhea and dehydration.
                                                You need to use a commercial
                                                kitten milk replacer. There are
                                                several brands available through
A special bottle with kitten milk replacer is   veterinarians and pet supply
used to feed an orphan kitten.                  stores.There are also pet nursing
                                             Pregnancy and Queening   111

bottles with small nipples. Kitten milk needs to be fed warmed, but not
hot—just like the milk you would give to a human baby.

Potty Me
Kittens do not have control over their urination and defecation until
they are about four weeks old. From birth until that time, their moth-
er normally stimulates them to eliminate by licking their genitalia. Of
course, you don’t have to go this far; you can simulate this action by
using a warm, damp washcloth or cotton ball, turning the kitten over,
and gently rubbing the genitalia until urine and feces pass.This should
be done after each feeding.

Keep Me Safe and Warm
Kittens do not have any body fat to keep themselves insulated. They
usually pile on top of each other next to their mom and share her heat.
If you have an orphan, you need to keep her warm using a hot water
bottle or a heating pad set on low; both should be covered with a towel.
Make sure the kitten has a way to crawl off the heating pad or bottle if
she becomes too hot. Except when you are handling her, a newborn
kitten should be confined in a small box with a towel in an area free
from drafts. Because newborns cannot see, it is essential to know where
they are at all times to keep them out of trouble.
    Orphans are weaned in the same manner as kittens raised by their
mothers.They can be introduced to a gruel of meat baby food at four
weeks of age. Litter box introductions are also recommended at this
    Behavior problems are common in orphaned kittens because they
miss out on being trained by another cat. Orphans tend to bite more,
be less tolerant of restraint and play roughly.They would not get away
with these actions if their mother, siblings or other cats were around.
Other cats teach manners and appropriate responses by biting back, rep-
rimanding with their paws and demonstrating by example. Exposing
orphans to humans and other cats at a young age helps. Don’t allow an
orphan kitten to bite you or play with you in an aggressive manner. It
only reinforces bad behavior.
Chapter 12

How to Care for
a Senior Cat

Cats do not live forever, although we’d like them to.When you have shared
your home with a cat for many years, he becomes an integral member of
the family, and you develop strong emotional attachments. Cats provide
undemanding and unending love.They are always there for you.
    You can prevent many problems that could shorten your cat’s life by
following the suggestions about care that are offered in this book. Cats
are very good at disguising their problems, so as they age, you need to
be even more attuned to changes in their everyday activities and behav-
iors. Early detection of problems is the key to improving your cat’s
longevity and quality of life.

There are many formulas for calculating a cat’s age in relation to human
age.An old standby is that seven cat years are equal to one human year.
Actually, in her first few years a cat does a lot more growing up than
that. So the first few years of a cat’s life are equivalent to more than

                                              How to Care for a Senior Cat 113

seven human years, and the later years are equivalent to fewer.The table
on page 114 compares the age of a cat with that of a human.
     Owners want to know what the life expectancy is for their cat, and
in general I tell them it is between 13 and 15 years, especially if the cat
stays indoors. However, we have many 19- and 20-year-old patients,
and our oldest is 24! If a cat goes outside, her life expectancy is short-
ened because of the increased risks outdoor cats face. She is exposed to
more diseases and dangers, such as poisons and cars.
     There are many different opinions on when a cat is “old.”There is no
consensus on the age at which a cat becomes a senior, but a Panel Report
on Feline Senior Care published in 1999 by the AAFP recommends
beginning a senior preventative health care program by 7 to 11 years of
age. By 12 years almost all cats start experiencing the effects of aging.
     There are certain diseases and conditions that occur in cats due to
degenerative processes. Each cell in an animal’s body is programmed to
last a certain amount of time, and this programming is different for each
individual animal. Some animals look and act old at 10 years, while oth-
ers are fit and spry at 15 years. Certain organs seem to age at a faster
rate than others, and this is perhaps why certain health problems are
more common in older cats.

Cats need the most veterinary and owner care when they are kittens
and when they are seniors. Middle-aged cats are usually healthy and
take pretty good care of themselves and can get by with once-a-year
visits to the vet for their physical exams.

                     SENIOR CARE PROTOCOLS

    The Panel Report on Feline Senior Care published by the AAFP
    recommends health care protocols based on a cat’s age and clinical
    signs. For cats 7 to 11 years and up, twice a year physical examina-
    tions and annual diagnostics are recommended. Other issues that are
    addressed in the report are behavioral changes, pain relief, anesthesia
    concerns, nutrition, dentistry and coping with the death of a pet.
    An awareness of all of these issues is essential to providing optimal
    care to senior cats.
114 Guide to a Healthy Cat

      1                 16                 11                 58
      2                 21                 12                 62
      3                 26                 13                 66
      4                 30                 14                 70
      5                 34                 15                 74
      6                 38                 16                 78
      7                 42                 17                 82
      8                 46                 18                 86
      9                 50                 19                 90
     10                 54                 20                 94

    Regular veterinary examinations will objectively note small, grad-
ual changes, which can add up to significant changes over a period of
time. Even if you’ve lived with your cat for years, you may not notice
subtle changes that occur in her conformation and health as she ages.
    A preventative health care program for healthy animals may include
a complete history and physical exam and some diagnostic testing,
including a CBC, blood chemistries, viral testing, urinalysis and meas-
uring blood pressure. I think it’s beneficial to start a program like this
around nine years of age.
    By establishing baseline values on body condition and organ func-
tion, you can detect changes as the animal ages. If a cat has an illness,
she should be monitored at least every six months.

Although you may not like to think about it, it’s a good idea to be
familiar with the kinds of problems a senior cat can develop. As with
any disease, early identification and treatment can help slow the progress
of the disease and prevent related maladies. There are six diseases that
are particularly common in senior cats:

    1.   Hyperthyroidism
    2.   Chronic renal failure
    3.   Hypertension
    4.   Cancer
    5.   Diabetes mellitus
    6.   Inflammatory bowel disease (IBD)
                                            How to Care for a Senior Cat 115

    Liver disease, heart disease, neurological diseases and lung disease are
also found in senior cats, but their frequency is greater in geriatric
humans than in cats.

Hyperthyroidism is very common in senior cats and is usually the result
of a benign growth on one or both of a cat’s thyroid glands, which are
located in the neck. The thyroid glands produce hormones that affect
general metabolism and organ function, and overactive glands make
excessive levels of hormones.
    Hyperthyroid cats produce too much of the thyroid hormones.
They can have ravenous appetites but still lose weight. They may have
rapid heart rates, arrhythmia (irregular heartbeat), vomiting and diar-
rhea.This disorder is diagnosed by a blood test, and treatment is aimed
at suppressing the gland medically or removing the overactive tissue by
surgery or radiation. Chapter 18 contains much more information
about hyperthyroidism in cats.

Chronic Renal Failure
Chronic renal failure is a degenerative process that slowly impairs the
important functions of the kidneys, which filter the blood and produce
urine.They are also responsible for water and electrolyte balance in the
body. Kidney function is measured through urinalysis and blood test-
ing, but these tests don’t even start to indicate problems until more than
50 percent of all kidney function has been lost.
    Cats with chronic renal failure typically drink a lot, urinate a lot and
lose weight. As kidney disease progresses, the cat becomes thin, dehy-
drated and develops a terrible odor from the mouth.
    Treatment of chronic renal failure is aimed at maintaining an
animal’s hydration and electrolyte balance as well as controlling some
secondary problems that are associated with kidney failure (these can
include anemia, dental disease and weight loss).

                      SOUNDS SIMILAR, BUT . . .

    Don’t confuse hyperthyroidism with hypothyroidism, in which the
    thyroid glands produce too few hormones. Hypothyroidism is rare
    in cats. Symptoms include lethargy, weight gain and a dull coat.
116 Guide to a Healthy Cat

                                                  You can help prevent kidney
                                              disease by feeding your senior
                                              cat a good diet that does not
                                              over-acidify the urine and pro-
                                              viding plenty of clean, fresh
                                                  The kidneys are organs that
                                              do not regenerate, so once they
                                              are damaged, disease will
                                              progress. By intervening with
                                              diet, fluids and other treatment,
                                              the process can be slowed but
                                              not cured. It is hard to know
                                              how quickly problems will
                                              progress,      so    monitoring
                                              changes in blood urea nitrogen
                                              (BUN) and creatinine will give
                                              a veterinarian an idea of the
Owners are often able to administer subcuta-  stage of degeneration. BUN
neous fluids at home to treat kidney disease  and creatinine are products that
and dehydration. A needle is placed under the
skin between the shoulder blades, and sterile
                                              are present at higher levels in
fluid is given.                               the blood when cats have kid-
                                              ney disease. However, as I’ve
                                              already mentioned, abnormally
high values of these products are not even detectable until more than
50 percent of kidney function has been lost.
     If it is detected in the early stages, kidney disease can be managed,
possibly for years. Management requires active owner participation and
care, including fluid supplementation.
     Chapter 20 contains more information about renal problems in cats.

High blood pressure (hypertension) does occur in cats. Most often it is
secondary to hyperthyroidism or chronic renal failure. Testing a cat’s
blood pressure can be tricky, because cats are generally stressed when
they go to a veterinary clinic and stress increases blood pressure.
Hypertension can be addressed by controlling the primary disease that
caused it, and by using oral medications.
    Chapter 16 contains more information about hypertension in cats.
                                            How to Care for a Senior Cat 117

Cats are living longer now than they ever have, and this has increased
the incidence of cancer. Cancer is new tissue produced by the unregu-
lated growth of cells.The cause of most cancers in cats is not known—
just as it is not known in humans. Some types of cancer progress rapid-
ly, while others are slow to spread. Some types are external and can be
observed by owners, and others are detected when a veterinarian is pal-
pating an animal during a physical examination.
     There are veterinary oncologists who specialize in animal cancer
treatment, and each year leaps and bounds are made in cancer treat-
ment. Many of the same types of drugs and therapies used for humans
are available for cats. And new, gene-based therapies are being studied
as possible treatments for pets even before they are being studied for
humans, as cancer care centers for both people and animals team up to
find the best ways to fight this terrible disease. The prognosis is differ-
ent for each type of cancer and for each individual cat.The treatments
available for cancer include:

     •   Chemotherapy
     •   Surgery
     •   Radiation
     •   Cryotherapy (freezing the cancer cells)
     •   Immunotherapy

    The goal of treating cancer in animals is to prolong life while main-
taining a good quality of life. It is not simply to keep an animal alive. If
an animal is having problems handling the treatment, it is changed or
discontinued.Veterinarians do not want the treatment to be worse than
the disease.

                   UNDERSTANDING THE LINGO

    Neoplasia is another term used to describe cancer. Neo means new,
    and plasia means abnormal growth.There are two types of neopla-
    sia: benign, which means nonaggressive and unlikely to spread and
    cause problems; and malignant, which means aggressive and likely
    to spread (metastasize) to other organs.
118 Guide to a Healthy Cat

    Cancer will cause a variety of clinical signs, depending on where
the cancer is. Most cats with cancer will have weight loss, elevated
white blood cell counts and anemia.The blood tests available today are
not geared to specifically detect cancer. Testing for cancer markers in
the blood of cats is not as advanced as it is in humans, but expect the
technology to be available in the future.

Diabetes Mellitus
A cat with diabetes mellitus is unable to properly use glucose, which is the
major source of energy for the body. The cat will eat food and produce
glucose in the blood, but that glucose will not be transported into cells for
nourishment, so even though the cat is eating, her body starves.
    The clinical signs associated with diabetes are similar to those of
chronic renal disease. Diabetic cats have voracious appetites, and they
typically drink a lot of water, urinate a lot and lose weight.
    The condition arises when the islet cells of the pancreas are unable
to produce enough insulin to metabolize the glucose. Insulin is the hor-
mone that allows glucose to enter cells in the body. Most diabetic cats
need to be given insulin injections twice a day. Chapter 18 contains
more information about diabetes in cats.

Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) is a problem that affects the lining of
the stomach and/or intestines. Cats with IBD typically have vomiting
and/or diarrhea that does not respond to conventional remedies. To
definitively diagnose IBD, biopsies of the stomach and intestine are
needed. Biopsies can be obtained using an endoscope (a tube with tiny
instruments at the end that is passed down the cat’s digestive tract—
under anesthesia, of course) or through exploratory surgery.
    Treatment for IBD involves reducing inflammation, controlling
infection and, usually, long-term medication. The prognosis for cats
with IBD is good, but IBD can progress in some animals to a type of
cancer called intestinal lymphosarcoma. Chapter 14 contains more
information about IBD in cats.

Liver Disease
The liver is a vital organ responsible for digestion, vitamin and mineral
storage, metabolic processes and removing wastes from the bloodstream.
If it is not too severely damaged by disease, the liver can regenerate.
                                          How to Care for a Senior Cat 119

    In a geriatric cat, the liver can become inflamed, infected or can-
cerous and stop functioning normally. Signs of liver disease include
jaundice (yellowing that is especially visible in the eyes), vomiting,
weight loss and anemia.
    Blood tests and palpation of the liver provide clues, but most liver
disease can only be diagnosed by a liver biopsy. Biopsies can be obtained
through exploratory surgery or with a needle guided by ultrasound.
Chapter 14 contains more information about liver disease in cats.

Heart Disease
Cats do not develop arteriosclerosis—clogged arteries that impair blood
flow to the heart and lead to heart attacks in humans. Instead, most
feline heart disease occurs in young and middle-aged cats.When a geri-
atric cat experiences heart failure, it is usually in connection with
another illness.
     As mentioned earlier, a common disease in older cats is hyperthy-
roidism, and when this condition is not controlled, heart failure can
occur.The heart muscle simply wears out after being overstimulated for
a period of time. When the heart fails, the rhythm of the heartbeat is
affected, fluid can pool in the chest and circulation can be impaired.
     Signs of heart disease include weakness, panting, open-mouth breath-
ing and coughing. Diagnostic tools available to evaluate heart disease
include X rays, ECG (electrocardiography) and ultrasound (echocardiog-
raphy). Chapter 16 contains more information about heart disease in cats.

Neurological Disease
Seizures are periods of abnormal electrical activity in the brain. If an
older cat has a seizure, possible causes may be hypertension, metabolic
imbalances or cancer. When routine diagnostic testing does not pin-
point a cause, other tests are available.
    To evaluate the neurological system of a cat, tests may include a
cerebral spinal fluid tap (CSF), magnetic resonance imaging (MRI) and
computer-assisted tomography (CAT scan). Chapter 19 contains more
information about neurological disease in cats.
    Cognitive dysfunction is another neurological disorder occasionally
seen in senior cats. It is characterized by disorientation and confusion,
disturbances of the sleep-wake cycle, reduced social interaction and loss
of housetraining. These signs must be present in the absence of hor-
monal or metabolic imbalances, medical diseases and other neuro-
logical problems to make the diagnosis. The diagnosis is tentative
120 Guide to a Healthy Cat

           DO CATS HAVE                      without a brain scan and
             STROKES?                        cerebrospinal fluid (CSF)
                                             analysis—a laboratory test
   Strokes are not very common in            that examines a sample of
   cats, so when neurological signs          the fluid surrounding the
   are present, other diagnoses need         brain and spinal cord. The
   to be considered. A stroke occurs
                                             drug selegiline (l-deprenyl)
   when oxygen flow to the brain
   is impaired and brain cells are           is used to treat cognitive
   damaged. A stroke could affect an         dysfunction, because it can
   animal’s ability to walk, eat and         increase dopamine levels in
   eliminate, so if improvement in           the brain (dopamine is a
   clinical signs is not seen within         chemical transmitter that
   a few days, the prognosis is poor.        carries nerve signals across
                                             the spaces between nerve

Lung Disease
Cats who have had life-long asthma or long-standing infections can
develop scarring in their lungs. As they age, the scarring can progress
and cause respiratory collapse. Cats can die suddenly from respiratory
collapse. If an animal’s lungs are unable to inflate properly, oxygen can-
not enter the blood and the animal can suffocate.
     Fluid also prevents the lungs from expanding, and certain disease
processes can cause fluid to build up in the lungs (pulmonary edema)
or within the chest cavity (pleural effusion). Both of these are poten-
tially life-threatening conditions.
     Cats who are having problems breathing will often sit upright, cough,
breath with their mouths open and clearly appear to be in distress.They
need immediate veterinary help. X rays of the chest cavity and removing
a small amount of fluid or lung tissue with a needle for examination
(called needle aspiration) can help diagnose the cause of lung disease.
Chapter 13 contains more information about lung disease in cats.

As different parts of the body wear out, it may be difficult for a cat to
maintain her regular activities. If you have an older cat, you want to be
sure to make things as easy as possible for your old friend.
    It is common for vision and hearing to be impaired as a normal part
of the aging process, although it is unusual for a cat to go completely
blind solely due to aging. If vision is compromised, the animal can
                                           How to Care for a Senior Cat 121

usually see better in daylight than at night. She will do better if impor-
tant items such as food bowls and the litter box are always kept in the
same areas where she can easily find them.
    Although it is best to keep all cats indoors, it is extremely impor-
tant to do so if your cat is deaf. Complete deafness occurs occasionally
in older cats.You should not let a deaf cat outside alone, because she
will not hear noises that would normally alert her to danger, such as the
sound of approaching cars.

The Importance of Water
Because kidney disease is so common in older cats, maintaining good
hydration can make a big difference in how an older cat feels. At my
clinic, we teach many owners how to give their cats fluid injections
under the skin at home to help maintain or improve their pet’s hydra-
tion. This process is called subcutaneous administration of fluids. (The
word subcutaneous is derived from sub, meaning below, and cutaneous,
meaning related to the skin. Instead of going directly into a vein,
fluids injected in this manner are absorbed by the blood vessels under
the skin.)
    It is difficult to make a cat drink under the best of circumstances,
but it is even harder when the animal is dehydrated and weak.
Depending on the cat and the owner, giving subcutaneous fluid injec-
tions can be easy. If this is something you would be willing to try, you
should discuss the procedure with your veterinarian.

Senior Nutrition
Because they are not building muscle and are less active than younger
cats, senior cats need less protein and fewer calories. As a cat ages, the
digestive and absorptive processes of the gastrointestinal system can
become less efficient. Many companies produce “senior” or “geriatric”
diets formulated for these situations. However, an active, healthy senior
cat does not automatically need to be eating a senior diet. Discuss your
cat’s condition with your veterinarian before you switch her diet.
     Dental disease is common in older cats and can affect how much and
what a cat will eat. Dental health should be assessed at each veterinary
visit, and the diet changed to accommodate the cat’s dental function.
     Softer foods that require little or no chewing may help an older cat.
For a cat with a poor appetite, dense foods that provide a lot of nutri-
tion in a small quantity can be appropriate. It is always important for a
senior cat to eat and at least maintain her body weight.
122 Guide to a Healthy Cat

It is inevitable that joints will develop at least some mild arthritic
changes over time. Arthritis, or degenerative joint disease (DJD), can
cause pain and restrict a cat’s movement. If a cat cannot get around well,
she may not be able to perform her normal functions.
     Arthritic cats who spend time outdoors are in danger because they
cannot run and jump as well as they might need to in a dangerous sit-
uation.When joints hurt, it is more difficult to jump down from places
the cat has jumped up on. It is a good idea to start keeping an older,
achy cat indoors for her own protection.
     The location and type of litter box might need to be changed for
an arthritic cat.You want to make it as easy as possible for the cat to get
in and out. Consider uncovering a hooded box or getting a box with
lower sides if the cat is having a hard time using it.
     The placement of food and water bowls should also be considered.
If a cat cannot move her head and neck well, elevating the bowl could
make a big difference in her ability to comfortably eat and drink. See
Chapter 17 for more information about arthritis.

Kitty Comforts
Older cats can lose body fat and muscle.They can become less insulat-
ed against cold temperatures and can develop calluses and “bed sores”
when bony parts rub against hard surfaces cats lie on. Be sure your cat
has something soft and warm to lie on, such as a towel, throw rug or
kitty blanket that will keep her more comfortable.

Bugs and Pests
As horrible as it sounds, insects like to take advantage of weak animals.
Older cats may not be able to move away or scratch when insects both-
er them. Insects want to get a meal as easily as possible, so if an animal
is not shooing them off, they are going to stay and eat.
    Check your older animal for fleas and use flea control when
needed. (Always make sure the product you are using is appropriate for
older cats.) If the cat goes outside, monitor the areas she sleeps in and
make sure ants are not bothering her.Also check to make sure that flies
are not bothering an outdoor cat. Flies can lay their eggs on animals
who don’t move away, and the eggs will hatch into maggots about 12
hours later.
                                             How to Care for a Senior Cat 123

Each owner will have different feelings about how far they are willing
to go financially and emotionally with the treatment of their cat.There
is no right or wrong when it comes to treating a geriatric cat with a
life-threatening illness. For some owners, a year or two more of life is
worth it; others are ready to say goodbye when the news is bad.
     I always tell owners that there is never a “perfect” time to make a
decision about a cat’s life. It is uncommon for a cat to die comfortably
and quietly in her sleep, and in most situations, an owner is faced with
a decision about euthanasia.
     The phrase “quality of life” is used a lot, but people don’t always know
what it means. My interpretation is that if an animal is able to eat, drink,
eliminate and get around reasonably well and does not seem to be in con-
stant pain, then her quality of life is probably pretty good. When these
basic functions cannot be performed, then quality of life is in question.
     Unfortunately, in many older cats, one part of their body is not work-
ing at all, but otherwise they’re in good health. Under these circumstances,
making a decision is difficult. We cannot truly assess how much pain an
animal is in with most diseases, so we use their clinical signs as a guide.

When an animal is “put to sleep,” she is given an overdose of an
injectable barbiturate anesthetic. If the injection is given intravenously,
the animal dies within 20 seconds. Everything in the cat’s body slows
to a stop, including the heart, so the process is painless.
    Cats do not close their eyes when they die. After death some cats
empty their bladders or have muscle twitches.This is all normal.
    Each of us has different feelings about death and what it means. A
few things to consider about euthanasia:

     • Do you want to be present when your cat is given the injection?
     • Do you want any special arrangements made for the body?
     • If there are young children in the family, how will you explain
       it to them?
     • Will you need help coping with the loss of your pet?

     As much as you do not want to have to plan for your cat’s death, it
is often hard to think clearly when the time comes. It is best to be pre-
pared so that you do not have to make hasty decisions later.
124 Guide to a Healthy Cat

Are You Crazy to Be This Upset?
I am upset any time I have to put a cat to sleep. Certainly, it is the worst
part of the job of being a veterinarian. I am able to derive comfort from
the fact that I know I am able to end an animal’s pain and suffering
through euthanasia. Anyone who has ever been close to a pet knows
how much it hurts emotionally when a pet dies, but people who have
not had pets often do not understand.
    I think it is normal to want to cry when a pet you have loved and
shared your home with dies. I personally feel sadder about putting a cat
to sleep when the owners are not upset. I think it is vital to let your
emotions out, whether you are a man or a woman. Why should you
have to keep them bottled up? Those of us in the veterinary profession
do understand how painful it is to make a decision about a pet’s life.
    All family members, even those who may have previously claimed
not to care about the cat, will feel some sort of loss with the animal’s
death. It is good to talk about it when possible. If there are children in
the family, let them know that you are sad too, but that all living crea-
tures will die at some time.
    If you live alone, you should tell others about the loss of your pet
so that friends and relatives can help you and be supportive of your feel-
ings.Although no one else you know may have felt the same way about
the pet as you did, other support options are available.These include:

     • Local pet loss support groups
     • Pet loss support hotlines available by phone
     • Web sites dedicated to pet loss

    See Appendix C for pet loss grief counseling hot lines.

Should You Get a New Pet?
Each person should go through a grieving period, but the length of time
will vary.A new cat will never replace an old one, but each animal should
find her own place in your heart. I personally think owners who feel a void
in their life from the loss of a pet should consider getting a new pet, because
they obviously have a lot of love that another pet would benefit from.
     You may or may not want to get the same color, sex or breed of cat.
The decision is up to you, but remember the new cat is not a replace-
ment—she is an entirely new family member.You must also remember
that if you get a kitten, her behaviors and your responsibility to the ani-
mal will be different from those you have been accustomed to.
Chapter 13

The Respiratory System

Breathing is a bodily function that healthy, normal animals usually do
not think too much about. The process is controlled automatically by
the brain and nervous system.
    The respiratory system of an animal has a lower and an upper part.
The nose and throat make up the upper respiratory tract and the tra-
chea and lungs make up the lower respiratory tract. Both parts must be
functioning for a cat to breathe normally.
    Animals exchange oxygen and carbon dioxide by breathing.
Oxygen is essential to maintaining life and body functions, so if an ani-
mal becomes starved of oxygen, it will die. Some of the diseases that
affect the respiratory tract of cats are life threatening, but others are
more of a nuisance and discomfort for the animal. This chapter will
introduce you to some of the most common disorders of the feline
respiratory system.
    A cat’s respiratory anatomy is very similar to ours. Although our
noses are shaped differently, and theirs are hairier, the functions are the
same. Air enters into the body through the nostrils (or, less often, the
mouth). Mucus and small hairs cover the lining of the nasal passages and
trap small particles and bacteria in the air.The air is warmed and mois-
turized as it passes through the nasal cavity and into the lower airways.
126 Guide to a Healthy Cat

Cats cannot blow their noses, and unfortunately because of this they
sneeze out a lot of junk.This sounds gross, and it is. Sneezing is a non-
specific sign that occurs when the nasal passages become stimulated by
secretions or an irritant.
    There is no “cure” for sneezing because there are so many different
causes. Possible causes of sneezing include:

     •   Viral infections
     •   Bacterial infections
     •   Fungal infections
     •   Allergies
     •   Irritants
     •   Foreign objects

     Antihistamines, decongestants and nasal sprays for humans are usu-
ally not very useful for sneezing cats. If you have a sneezing cat, the best
thing to do is have her examined by a veterinarian, so that a cause can
be determined and a specific treatment suggested.
     Although examining your cat’s nasal discharge is not a pleasant task,
the color and consistency hold clues. In general, if the discharge is clear
and watery, it is nothing to worry about. If the discharge is green, yel-
low or bloody, medical care is required. Cats can get bloody noses from
dry air and irritation, just like we do, but a bloody nose can also be a
sign of severe infection or even a nasal tumor.

Although most cats with allergies have itchy skin, some do sneeze. Cats
can be allergic to just about anything in the world, including pollen,
house dust and even kitty litter. Allergies usually produce a clear dis-
charge when the animal sneezes. Allergies can be managed, but they
can’t be cured.
     It can be quite difficult to determine specifically which allergen is
causing the cat to sneeze. Although it is impossible to test a cat for all
possible allergens, your vet can test for some common ones. If specific
allergens are identified, you can either remove them from the environ-
ment or try to desensitize the animal with allergy shots.
                                                The Respiratory System 127

Smoke, cleaning products and even a cat’s own hair can irritate the nasal
passages and cause sneezing. To determine if an irritant is causing the
sneezing, it must be removed from the environment and then the
sneezing must cease.
     Cigarette smoke can be very irritating to cats, and cats are suscep-
tible to all of the problems of secondhand smoke that humans are.These
include sneezing, bronchitis and even lung cancer. If you smoke, try to
keep the smoke away from your cat.

Foreign Bodies
Cats are like small children; they are subject to accidents, and objects
can become lodged in their noses. The most common object to get
stuck in a cat’s nose is a blade of grass. If you have a cat who sneezes 8
to 10 times in a row, it might be due to a foreign object stuck in her
    It can be difficult for a veterinarian to find something in a cat’s nose
without sedating the animal. Most cats are not thrilled with the idea of
having a scope put up their nostril or keeping their mouth open while
a veterinarian probes the back of the mouth. In some cases a special
fiber optic scope is needed to look into the rear nasal passages. This is
called rhinoscopy.

How You Can Help Alleviate Sneezing
Wiping a cat’s nose and keeping it free of discharge will help improve
the animal’s comfort. If the cat sounds congested, you may try putting
her in a steamy bathroom or in a small room with a vaporizer to help
open up the airways. Seek veterinary advice if the sneezing persists or
if the cat is showing signs of discomfort.

Upper respiratory infections are common in cats, and they can be
caused by viral, bacterial or fungal infections. These kitty colds can
range from mild to severe, with kittens being the most susceptible to
infection. Cats are routinely vaccinated against some of the agents that
cause upper respiratory infections. However, vaccines only decrease the
severity of the clinical signs and do not completely prevent infection.
128 Guide to a Healthy Cat

    Upper respiratory infections can last a few days to weeks, so it
important to monitor your cat’s clinical signs and work with a veteri-
narian if you are not seeing any improvement.These colds can be very
annoying and frustrating infections to deal with.
    Stress and crowding are two factors that increase the risk of an
upper respiratory infection. It is very common for a cat who has been
adopted from a shelter or foster home to start off healthy, only to devel-
op a cold shortly after her arrival in her new home. The animal was
likely exposed to a microorganism that caused the infection before she
was adopted, but the stress of being in a new home weakened her
immune system and triggered the infection.

Viral Infections
Viruses are the most common cause of kitty colds. The good news
about viruses is that they go away on their own over time, but the bad
news is that it can take a long time and there is not any specific treat-
ment or cure.The clinical signs typical of a viral upper respiratory infec-
tion are sneezing, runny nose, runny eyes, mild lethargy, decreased
appetite and fever.
    A veterinarian may treat a cat with a viral upper respiratory infec-
tion with fluids, antibiotics, ophthalmic medication, pediatric nasal
sprays, antihistamines, immunostimulants or with nothing at all.
Treatment depends on the clinical signs exhibited by the cat.
    Two immunostimulants used by many veterinarians are l-lysine, an
amino acid supplement that has shown antiviral effects, and alpha inter-
feron, a genetically engineered human product that has effects against
viral RNA, DNA and cellular proteins.
    Most veterinarians will base their diagnosis of a viral upper respira-
tory infection on their interpretation of the animal’s clinical signs.
Definitively diagnosing viral upper respiratory infections is difficult

                              KEEP EATING!

    Sick cats must eat and drink. Cats with upper respiratory infections
    will often have decreased appetites because they cannot smell. If
    your cat is not eating, try offering her smellier canned cat food,
    baby food or tuna.You can also try heating food in the microwave
    oven for a few seconds to increase its aroma. If the cat will not eat
    on her own, she will need to be hand-fed or even force-fed.
                                                The Respiratory System 129

because the lab tests that                 CAN MY CAT CATCH
isolate viruses are expen-                       MY COLD?
sive, can take weeks for
results and may only be 50           Cats get upper respiratory viruses
percent accurate. Don’t get          and people get upper respiratory
too frustrated if your vet-          viruses, but we do not pass them
erinarian cannot make a              back and forth. Cold viruses are
                                     host-specific.That means the kinds
positive call on the cause of        of viruses that attack cats do not
infection. Continue to pur-          attack people, and vice versa.
sue treatment options if
you think your cat is
    Feline rhinotracheitis is a very common cause of upper respiratory
infection, and because it is a herpes virus, it can cause recurrent disease.
Cats infected with rhinotracheitis can have colds and conjunctivitis off
and on as kittens, but they tend to grow out of it by the time they are
two years old.-

Bacterial Infections
Bacterial upper respiratory infections can occur on their own or as sec-
ondary infections along with viruses.The clinical signs associated with
bacterial infections are:

     •   Fever
     •   Enlarged lymph nodes
     •   Yellow to green discharge from the nose and/or eyes
     •   Sneezing
     •   Coughing
     •   Decrease in or loss of appetite
     •   Lethargy
     •   Dehydration

    Treatment is aimed at killing the bacteria and supporting the cat.
Treatment can include antibiotics, fluids, ophthalmic medications, anti-
histamines, pediatric nasal sprays, immunostimulants and hand feeding.
Bacterial cultures are not routinely run on cats that develop acute upper
respiratory infections, but they may be performed if the infection does
not resolve, worsens or becomes chronic.
130 Guide to a Healthy Cat

        ACUTE OR CHRONIC?                      Culturing the specific
                                           bacteria that are causing
    The terms acute and chronic are        an upper respiratory
    used to describe diseases. Acute       infection is difficult,
    means a disease comes on sudden-       because the nose is also
    ly and eventually goes away. A         the home of many normal
    chronic disease is one that lasts for  bacteria that can contami-
    a long time or that does not com-
    pletely go away.                       nate a culture. To get a
                                           more reliable culture
                                           specimen the cat should
                                           be sedated, sterile saline
flushed into a nostril, and a sample collected from the back of the
nasal passages.

Fungal Infections
Fungal upper respiratory infections occur occasionally, with Cryptococcus
neoformans being the most common fungus. Cats with compromised
immune systems, such as those infected with FeLV or FIV, are most at
risk for developing fungal upper respiratory infections.This fungus can
be found in bird droppings and, as unlikely as it seems, it can affect cats
who live indoors.
    Fungal upper respiratory infections are usually slowly progressive and
do not improve with antibiotic treatment. As fungal infections progress
they can cause growths in the nostrils and bulging of the sinuses. Fungal
upper respiratory infections may be diagnosed by examining a smear of
nasal discharge microscopically, by performing a blood test for
Cryptococcus or other fungi common in your area, or by a biopsy or nee-
dle aspirate of a nasal growth. Antifungal drugs are effective against fun-
gus, but the treatment may last months and the drugs are quite expensive.

If the Cold Doesn’t Go Away
If treatment by your veterinarian is not helping, more aggressive care
and hospitalization may be needed. Other diagnostic tests should be
done that will look for other diseases that can mimic upper respiratory
infections, including:

     • Complete blood count and blood chemistries
     • FeLV and FIV tests
     • Microscopic evaluation of nasal discharge
                                                The Respiratory System 131

     • Bacterial culture
     • Fungal blood titer and/or culture
     • Skull X rays
     • Rhinoscopy (examination of the back of the nasal passages
       with a fiberoptic scope)
     • Nasal biopsy
     • Tracheal or bronchial wash
     • Bronchoscopy

    Other possible diagnoses are nasopharyngeal polyps (growths that
block the back of the throat), inflammatory conditions, sinus infections
and neoplasia (abnormal tissue growths). These other diseases will not
respond to conventional upper respiratory infection treatments.

Cats do get asthma. Asthma is a form of bronchitis—an inflammation
of the large airways in the lungs called the bronchi. In asthma attacks, the
muscles surrounding the airways constrict and the internal lining of the
airways swell. This combination blocks adequate oxygen from passing
through and creates respiratory difficulty.
    Allergies or irritants can cause asthma, and since asthma affects the
lungs, it is a lower respiratory disease with serious implications. Diseases
that affect the lower respiratory tract are potentially more dangerous
because the lungs can be permanently damaged.

Signs of Asthma
The clinical signs associated with asthma include:

     •   Coughing
     •   Gagging
     •   Increased respiration rate
     •   Open-mouth breathing
     •   Wheezing
     •   Lethargy
     •   Difficulty breathing and distress

    The number and severity of the clinical signs is usually in proportion
to the severity of the asthma. Asthma can progress to a life-threatening
132 Guide to a Healthy Cat

situation. It can only be diagnosed definitively by an X ray. A complete
blood count could also be a helpful test, because some cats with asthma
have higher levels of a specific type of white blood cell called an

Treating Asthma
There are various drugs veterinarians prescribe to treat asthma, includ-
ing cortisone, antihistamines, bronchodilators, antibiotics, oxygen and
even some asthma drugs made for humans. Most of the time the cause
of asthma is not found, but it is often linked to allergies. A condition
linked to allergies is managed rather than cured, and the cat can have
recurrent problems.
     Do not treat your cat for asthma unless she has had a chest X ray.
The clinical signs that are typical of asthma can also be present with
heart disease or when fluid is present in the chest cavity, and these seri-
ous conditions require very different treatments.
     Observant owners can tune in to their cats and detect asthma, when
it recurs, at an early stage. The early clinical signs are a nonproductive
(no phlegm comes up) cough or gag. Some cats need to be on long-
term medication to control their problems, and medication can be
injectable, oral and/or delivered by an inhaler.
     Inhalers are being more widely used to treat cats with chronic asth-
ma. Special chambers with one-way valves and a mask are used to deliv-
er the medication into the cat’s airways, because, as you can imagine, it
is impossible to make a cat breathe in when an inhaler is depressed.
Human inhalers containing cortisone are used first, and if the response
is inadequate, inhalers with bronchodilators are added. Benefits of
inhaler treatment are that medication is immediately delivered directly
to the location of the problem—the lining of the airways—and side
effects of long-term cortisone use are eliminated, since medication is
not entering the bloodstream.

                    IT’S NOT ALWAYS HAIRBALLS

    When cats cough and gag, owners can be quick to blame the prob-
    lem on hairballs. Although initially an asthmatic cat may appear to
    be coughing up a hairball, nothing will come up and the problem
    will progress. Do not ignore this important clinical sign of asthma.
                                                            The Respiratory System 133

An inhaler will be attached to this chamber and mask to deliver asthma medication directly to
the cat’s airways.

    Allergy testing and hyposensitization (giving allergy shots) helps some
cats with asthma. Eliminating inhaled irritants in the cat’s environment,
such as cigarette smoke, dusty cat litter and construction dust, helps, too.
    Some cats can have lifelong asthma that causes permanent damage
to the lungs through scarring. Scarring prevents the lung tissue from
expanding normally, and as it progresses can lead to respiratory collapse.
Managing the inflammation, by effectively treating asthma, helps pre-
vent scarring.

Pneumonia is an infection in the lungs.Viruses, bacteria and fungi can
all cause pneumonia. Pneumonia is most common in young cats and is
infrequent in adults. It is a serious condition, because if it progresses, it
can lead to severe congestion within the lungs and respiratory collapse.
     Young cats can get pneumonia by choking and aspirating fluid into
their lungs. This might occur when a bottle-fed kitten does not suck
normally and the milk is swallowed improperly. Pneumonia can then
ensue. A cat might also get pneumonia when she has another disease
that has weakened her immune system and allowed infection to travel
down into the lower respiratory tract.
134 Guide to a Healthy Cat

     A third cause of pneumonia could be parasites.There is, for exam-
ple, a species of worm known as Aelurostrongylus abstrusus, which like to
live in the lungs and cause infections. These worms can be carried by
the birds, frogs or rodents that cats eat when they hunt. Sometimes gas-
trointestinal worms migrate in an abnormal manner and become
lodged in the lungs. In addition, a protozoal parasite, Toxoplasma gondii,
can occasionally cause pneumonia in cats.
     Pneumonia can only be definitively diagnosed by a chest X ray.
Additional tests are needed to pinpoint the cause of infection.
     Because a lower respiratory tract infection poses much graver risks
than an upper respiratory infection, aggressive therapy is needed. A cat
with pneumonia usually requires hospitalization, intravenous antibiotics,
fluids, diuretics, bronchodilators, oxygen and nebulization. Nebulization
is a process in which saline and antibiotics are mixed and turned into
very small particles that are made into a mist. This mist can enter the
lower airways when an animal breathes in.
     The prognosis for a cat with pneumonia is uncertain. If the infec-
tion responds to treatment and the lung is not permanently damaged,
recovery is possible. The longer the lung stays congested, the harder it
is to treat.
Chapter 14

The Gastrointestinal

If your cat is anything like either of my cats, eating is an important part
of each day.Taking in and processing food sustains life for a cat, so dis-
orders of the gastrointestinal (GI) tract can have serious implications.
The gastrointestinal system includes many organs and extends from the
mouth, to the esophagus, to the stomach, to the small intestine, to the
large intestine and finally to the rectum.Along the way the liver and the
pancreas get into the act.
    There are many diseases that can affect the GI tract. In this chapter,
I will describe some of the diseases and some common signs of GI
problems. Diet, stress, infectious agents, parasites and age all play a role
in GI health.

Digestion begins in the mouth with food being taken in by the lips,
chewed by the teeth, mixed with saliva and pushed into the esophagus
by the tongue. I don’t know if cats ever have good breath, but cats with

136 Guide to a Healthy Cat

disease in their mouths have noticeably bad breath. Bad breath can be
an indicator of dental disease, gum disease or problems with the tongue.
    Even if you perform routine dental care on your cat, dental disease
can occur. A veterinarian should perform a dental exam on your cat at
least once a year and evaluate the teeth, tongue and gums. Just as some
people have bad teeth, some cats naturally have bad teeth. Others devel-
op bad teeth because of diet and lack of care. Teeth can break, crack,
develop erosions, abscess and fall out on their own. Owners are some-
times shocked when I show them that their cat is missing teeth. They
cannot believe how well their cat is eating. Decreased appetite or prob-
lems eating are not always present in oral disease, and cats with signifi-
cant infection or inflammation in their mouths may eat normally.
    Infections from the mouth can get into the blood and spread to
other organ systems, so regardless of age, cats with dental disease must
be treated. Before performing any dental procedures, a cat’s general
health and metabolic state should be assessed and stabilized.

Gum Disease
The signs of gingivitis or gum disease are red or swollen gums, gums
growing up and over teeth, drooling, bad breath and inflammation at
the corners of the mouth, making the mouth difficult to open.
    Similar to other disease processes, the longer gum disease persists,
the harder it is to control or cure. Early intervention against gum dis-
ease is very helpful. When significant gum disease is present, causes to
consider are:

     •   Feline Leukemia Virus (FeLV)
     •   Feline Immunodeficiency Virus (FIV)
     •   Tooth infection
     •   Inflammatory condition
     •   Neoplasia

     A cat with bad gums should be tested for FeLV and FIV. If these
tests are negative, the teeth should be cleaned and any affected teeth
repaired or removed. A gum biopsy and treatment with antibiotics may
be necessary if there is significant gingivitis.The biopsy results can then
guide any further treatment.
     There is a group of inflammatory conditions of unknown origin
that can cause severe dental disease and oral inflammation. An example
                                            The Gastrointestinal System 137

is called lymphocytic-plasmacytic stomatitis. Treatment of this condi-
tion can include cortisone, antibiotics, immunostimulants and full-
mouth dental extractions. Some veterinarians treat this condition with
lasers. Inflammatory conditions tend to be chronic and very painful if
not adequately controlled.

Cats vomit frequently, and owners hate to clean up after them. When
cats live in the wild vomiting is not a big deal, but when they live in
our homes it can create quite a mess. Sometimes vomiting is normal,
but other times it is an indication of disease.
    Some of the most common causes of feline vomiting are:

     •   Hairballs
     •   Sensitivity to a diet
     •   Eating too quickly
     •   Viral or bacterial infections
     •   Consumption of plants or other nonfood items
     •   Inflammatory conditions
     •   Metabolic imbalances
     •   Gastrointestinal parasites
     •   Foreign body ingestion
     •   Intestinal obstruction

Spitting Up Hairballs
If you have a cat who grooms himself regularly, you are probably famil-
iar with hairballs. Some cats spit up hairballs regularly (that is, once or
twice a week) and others may only produce a hairball a few times a
year.The first time you see a hairball, you may not be sure which end
of the cat it came out of, because hairballs can appear as long, tubular
     Many cats like the taste of lubricant hairball remedies and will read-
ily lick them from your fingers. But hairball remedies do not cure hair-
balls; they merely help the hair to pass through the cat’s GI tract (one
way or the other) so that it does not cause an obstruction in the intes-
tines. Commonly found hairball remedies include lubricant pastes, fiber
138 Guide to a Healthy Cat

supplements, special diets and treats. If your cat spits up hairballs regu-
larly, one or more of these remedies may decrease the frequency.
Mineral oil is not a safe or effective treatment for hairballs.
     It is common to blame a cat’s coughing and gagging on hairballs,
but there are some serious conditions that can mimic the same
signs (see Chapter 13). If your cat is not spitting up a hairball when
he goes through those heaving motions, consult your veterinarian.
Possible causes could be asthma, heart disease and other gastrointestinal

Does Your Cat Have Food Issues?
Many cat owners know their cats do not always perform the second
step of digestion—chewing the food. Cats who eat rapidly without
chewing may regurgitate their meal within minutes and then simply go
back to eating. Cats may eat rapidly because they feel competition at
the food bowl or because they like to overeat. Cats who regurgitate
tend to bring up piles of food that has not been chewed.These cats usu-
ally eat a dry (but sometimes canned) diet too quickly, which blows up
and distends their stomachs, causing the regurgitation. Some sugges-
tions for curbing this problem are:

     • Feed a less palatable diet.
     • Feed a diet with a larger kibble size so that the cat will have
       to chew.
     • Add water to moisten the food before it is fed.
     • Mix canned food with the dry to slow down eating and add

    If you try these all of these suggestions and your cat continues to
regurgitate, consult your veterinarian.

Does Your Cat Have the Flu?
Cats can contract viral or bacterial infections that cause vomiting.
Because routine blood tests may show normal results, it is not easy to
diagnose a gastrointestinal infection. If fever and discomfort are present,
an infection should be suspected.
    It is common for cats with infections to also have diarrhea.
Infections can be contagious to other cats, but are rarely transmissible
                                           The Gastrointestinal System 139

to humans or other species.When possible, an exact cause for vomiting
should be determined.

Other Causes of Vomiting
A cat who is vomiting and is unable to hold down food and water can
get dehydrated and feel quite poorly. If you have a cat with these symp-
toms, have him checked out as soon as possible. A veterinarian may
want to treat the cat with fluids to improve hydration and also use other
injectable medications. Injecting the medications will ensure that they
get into the cat’s system, rather than being vomited up.
    Although blood tests are not very specific when it comes to diag-
nosing gastrointestinal disease, your veterinarian should perform them
nonetheless. Other diagnostic tests that may be needed include:

     •   Fecal exam
     •   X rays
     •   Abdominal ultrasound
     •   Barium upper GI series
     •   Endoscopy
     •   Abdominal exploratory surgery
     •   Biopsy of the stomach and intestines
     •   Hypoallergenic food trial

    Veterinary medicine is quite advanced with diagnostic options.
Depending on where you live, some of these tests are readily available.
Tests that use high-tech equipment tend to cost more money but are
very effective at reaching a diagnosis.

What Is a Foreign Body?
A foreign body is an inanimate object a cat swallows and cannot digest.
Any time a cat eats something other than his food, veterinarians call it
dietary indiscretion. Cats may ingest plants, strings, cat toys, holiday
decorations and even pieces of shoes and clothing.
    We think of cats as being picky and extremely discriminating. So
how is it that they willingly swallow inanimate objects that can lodge
in their intestines? The answer to the question of dietary indiscretion is
a mystery. It could be cats’ hunting and stalking behavior gets the best
140 Guide to a Healthy Cat

                         PUT AWAY THE TOYS

    I have observed my own cats’ attempts to swallow the string on
    their fishing pole toys. I now keep the toys in a closed closet when-
    ever they are not in use.To protect your cat from potentially dan-
    gerous objects, such as toys with strings, sewing materials, ribbon
    and newspaper ties, store them in a secure place.

of them. They chase and pounce on a quick moving object and then
ingest it as they would captured prey.
    Another possible explanation is boredom. Cats like to indulge in
attention-seeking behaviors. Some cats even seem to like being scolded
and chased away from trouble. Playing with items they fish out of trash
cans can be a game, as well. Unraveling balls of yarn or pulling apart a
carpet or drape can be lots of fun. It is even more fun for the cat when
you yell and run after him!
    Early detection of foreign bodies means they can be successfully
removed from the stomach and intestines of the cat. If not found
promptly, foreign bodies can cause the intestines to become blocked
or coiled, which can progress to intestinal rupture—a life-threatening
situation. Some foreign objects can be easily found on an X ray, while
others cannot and may not be found without exploratory surgery.
    Although it may sound extreme, if you have a cat who is unable to
hold down food or water, exploratory surgery can be the best way to
find a foreign body that cannot be seen on an X ray.The risk of wait-
ing for other diagnostic tests that may (or may not) show the problem
can outweigh the risk of surgery.

Diarrhea is another common problem in cats. It can have many of the
same causes as vomiting, and it requires the same diagnostic work-up.
If your cat has diarrhea, a veterinarian will want to examine the cat and
a fecal sample, because parasites are a frequent cause of diarrhea. If a
fecal check is negative and the animal’s physical exam is relatively nor-
mal, other diagnostic tests should be considered.
                                               The Gastrointestinal System 141

    Diarrhea can be a sign of a mild problem, or it can indicate a seri-
ous condition. A cat can have one episode of diarrhea, which is not a
big deal, or he can have chronic diarrhea and weight loss, which needs
significant care.

Bland Is Better
A diet change or dietary sensitivity can cause diarrhea.Any time a cat eats
something new, there is the possibility of gastrointestinal upset. Cats can also
develop intolerance to foods that they have previously handled just fine.
    Feeding your cat a bland diet and withholding treats and people
food is always a good idea if he has diarrhea. A bland diet is one that is
low in fat and easy to digest. Some cats will eat rice if it is mixed with
canned food; the rice can help bind up their feces.
    As contrary as it seems, feeding a cat who has diarrhea a high-fiber
diet can firm the stool. Fiber helps stimulate normal GI contractions,
reduce bacteria in the bowel and promote water reabsorption—all of
which can lessen diarrhea.

Check Out the Litter Box
Although you probably do not want to talk about the size, shape and
consistency of your cat’s stool, these factors will help your veterinarian
determine the cause of the problem. Helpful observations are:

     •   Is the stool formed (as opposed to watery)?
     •   Is there mucus present?
     •   Is there blood in the stool?
     •   Is there an abnormal odor?
     •   Can the cat make it to the litter box?
     •   When was the last normal stool?

    Seeing blood in your cat’s stool is scary, but it is unlikely to be a sign
of grave illness. A cat with an irritated colon will pass bright red blood
or clots. A cat with bleeding in the stomach will pass dark to black
stools, because the blood is partially digested along the way.A one-time
episode of blood in the stool may be insignificant, but if it continues,
check with a veterinarian.
142 Guide to a Healthy Cat

                             WHAT’S A BIOPSY?

    Endoscopic biopsies are obtained by passing a fiber optic endoscope
    into the GI tract of an anesthetized cat.The scope enters the
    mouth, goes down the esophagus, enters the stomach and then
    passes into the intestines. Along the way all of the tissues can be
    examined and little bits of the tissue of the linings can be removed
    (called pinch biopsies).This diagnostic test is limited to the lining of
    the tubular GI tract, and it cannot tell you about the outer layers,
    lymph nodes, liver or pancreas.
       There are risks and benefits to the different methods of obtain-
    ing biopsies. Needle biopsies do not require exploratory surgery,
    but they only provide a small number of cells for analysis. Surgical
    biopsies provide many cells and are more likely to confirm a diag-
    nosis, but they are obtained in a more invasive manner. During
    exploratory surgery, though, tissues are visualized, palpated and
    more thoroughly assessed.

Inflammatory bowel disease (IBD) is a condition in cats that can cause
diarrhea and/or vomiting. A diagnosis can only be confirmed by a
biopsy, which can reveal an abnormal infiltration of inflammatory cells
into the lining of the stomach and/or intestines. Biopsies can be
obtained through endoscopy or surgery.
     When other causes of GI disease have been eliminated, IBD
becomes a more likely diagnosis, although its specific cause is rarely
found. Researchers think the bowel inflammation results from a sensi-
tivity to proteins in the diet and an abnormal immune response. This
same inflammatory response can affect the liver and pancreas of cats.
When IBD, cholangiohepatitis and pancreatitis are all diagnosed in the
same cat, it is called triad disease.
     Cats affected with IBD vomit and/or have diarrhea. It is typically a
disease of middle-aged to older cats, but it can affect young cats, too. It
is always best to make a definitive diagnosis of IBD through biopsy but
in some situations this may not be possible.
     Treatment for IBD may include special diets, supplements, antibi-
otics, cortisone and other anti-inflammatory drugs. IBD is a condition
that cannot be cured, but can be managed.
                                             The Gastrointestinal System 143

Helicobacter are spiral bacteria found in biopsies of some cats’ stom-
achs. The significance of this organism in cats is unknown. One type
found in humans, called Helicobacter pylori, has been linked to the devel-
opment of stomach inflammation, peptic ulcers and even stomach can-
cer.Whether these specific bacteria can pass between cats and humans
is unknown, but it has not been isolated in feline feces. Helicobacter felis
is more commonly found in cats.
    Helicobacter probably causes gastritis and vomiting in cats and may
predispose them to food allergies and inflammatory bowel disease.
Metronidazole alone or in combination with other drugs is used when
clinical signs are present.

Cancer can only be definitively diagnosed by a biopsy. A type of intes-
tinal cancer called intestinal lymphosarcoma (LSA) is common in cats.
Intestinal lymphosarcoma can result from uncontrolled inflammatory
bowel disease. The clinical signs associated with this disease are similar
to IBD, but by the time it has progressed to cancer, the cat is usually in
much worse physical condition. Cats with intestinal LSA can respond
favorably to chemotherapy.
    Intestinal adenocarcinoma is another type of cancer seen in cats. If
this type of cancer has not metastasized, the treatment is surgical
removal. The affected piece of intestine is surgically cut out, and the
intestine is reconnected—similar to removing a bad piece of garden
hose! Adenocarcinomas do recur, but surgery has the potential to
extend the cat’s life by several good years.

Cats normally have one bowel movement a day. When stools become
less frequent or straining is observed, it is important to determine:

     •   Is the cat able to pass stool?
     •   Is the cat eating?
     •   Is the cat dehydrated?
     •   Could the cat be straining to urinate instead?
     •   Is the cat defecating somewhere else in the house?
144 Guide to a Healthy Cat

    If your cat is constipated, there are a few things you can try at home.
If you have any type of lubricant hairball remedy, these products also
work as laxatives. Adding one teaspoon a day of psyllium, which is the
ingredient in Metamucil and other fiber remedies, to cat food can also
help the irregular cat. (Make sure the fiber remedy you choose contains
only psyllium.) You may try feeding canned cat food and encouraging
water consumption. Feeding canned pumpkin (pumpkin pie filling or
plain cooked pumpkin) is another home remedy that can resolve con-
stipation.Try one tablespoon, once or twice a day.
    Don’t let your kitty go more than two days without passing a stool.
If you think an enema is needed, let your veterinarian administer it and
then deal with cleaning up any mess. Never give a phosphate enema
designed for a human to a cat—they are toxic to felines!
    There are many reasons why a cat may become constipated, and it is
a good idea to narrow down the possibilities so you can prevent recur-
rences. Causes of constipation include hairballs, dehydration, metabolic
diseases, anatomical deformities, arthritis, megacolon and diet.
    Megacolon is a chronic condition that causes constipation. The
colon becomes dilated and stops having normal muscle contractions.
Feces pack up and are not pushed through. Megacolon can be a pro-
gressive condition that needs long-term medical and dietary manage-
ment. Cats who do not respond to treatment need a surgery, called a
subtotal colectomy, to remove the inactive colon and restore the ability
to defecate.
    If your cat has more than one episode of constipation, work with
your veterinarian to determine a diagnostic and treatment plan.
Treatment can involve fluids, stool softeners, motility-enhancing drugs
that promote intestinal contractions and even shaving a cat to reduce
hair in the stool.

                       STRAINING FOR WHAT?

    Cats have different postures for urinating and defecating, but if you
    are not sure and the animal is straining, you should take him to a
    veterinarian as soon as possible. Instead of being constipated, the
    cat may be unable to urinate. Urinary blockages can become life-
    threatening situations within a very short period of time—as little
    as 12 hours.
                                             The Gastrointestinal System 145

The liver is a vital organ with many functions, including digestion, vita-
min and mineral storage, protein synthesis, general metabolism and
toxin neutralization. A cat can become very sick when his liver is
    Most of the signs of liver disease in cats are similar to those of other
gastrointestinal problems, but one different sign seen in many cases is
jaundice. Jaundice is a condition causing the eyes, skin and gums of an
animal to take on a yellow tint. The color change is due to bile pig-
ments in the blood that rise to abnormal levels in liver disease or gall
bladder obstruction.

What Is a Fatty Liver?
Cats who do not eat begin to break down their body fat for energy.
Even though many cats are overweight and have lots of energy stored,
the liver becomes overwhelmed by the amount of fat it must convert,
and a condition called hepatic lipidosis—fatty liver disease—can devel-
op. Cats who start off with other problems, such as viral infections, can
develop hepatic lipidosis if they stop eating. If the process continues,
hepatic lipidosis can become life threatening.
     A diagnosis of hepatic lipidosis can only be confirmed by a liver
biopsy, but this disease should be suspected if a blood test shows elevat-
ed liver enzymes and a cat is not eating. Needle biopsies of the liver can
be obtained with the aid of ultrasound, and wedge biopsies can be
obtained through exploratory surgery.
     If your cat is not eating for more than a day, it is crucial to get food
into him as soon as possible. If you are unable to entice the cat with
tuna, baby food or canned food, consult your veterinarian. Every day
makes a difference when trying to prevent hepatic lipidosis.
     Treatment for hepatic lipidosis may include force-feeding, treat-
ment of an underlying medical condition, supplementation with essen-
tial amino acids such as taurine and carnitine, placement of a feeding
tube, and extended supportive care for weeks to months.
     A feeding tube can be a lifeline for a sick cat. Owners are able to
easily feed their anorexic cats when tubes are in place. Tubes can be
placed through the nose or esophagus into the stomach, or they can be
placed directly into the stomach or intestine. Nasogastric tubes (nose to
stomach) can be irritating. They are very narrow and so limit feeding
146 Guide to a Healthy Cat

that they are best used only in a short-term situation.Veterinarians cur-
rently favor esophagostomy tubes (a tube placed into the esophagus)
because they can be easily placed in a sedated patient. Cats can still eat
and if there are problems with the tube, there is no risk of peritonitis
(infection of the abdominal cavity).Tubes placed directly into the stom-
ach or intestine are more technically complicated, require general anes-
thesia, and leakage can cause peritonitis.

Other Causes of Liver Disease
Hepatic lipidosis is generally considered to be a secondary problem,
occurring after another disease has caused loss of appetite. Some pri-
mary liver diseases are:

     •   Viral, bacterial, or parasitic hepatitis
     •   Cholangiohepatitis
     •   Exposure to toxins
     •   Congenital disease
     •   Liver shunts
     •   Hepatic neoplasia

     A cat’s liver is comprised of four lobes and may fill up to one-fourth
of the animal’s abdominal cavity. Seventy to 80 percent of a liver can be
impaired before functional problems are apparent.
     Blood tests can indicate that inflammation of the liver is occurring,
and they can indicate that liver function is significantly impaired, but
they are not specific when it comes to determining cause.A liver biop-
sy is needed to make a conclusive diagnosis.
     Almost all cases of liver disease have similar clinical signs. Some types
of liver disease are easier to treat than others, and the liver is an organ
that can regenerate if it is not too severely damaged. Bleeding disorders
can be a secondary problem in cats with liver disease, since the liver is
responsible for creating the components needed for blood clotting.

This disease is an inflammatory condition of the bile ducts and liver.
Vomiting, anorexia and jaundice are common signs in affected cats.The
cause of cholangiohepatitis is rarely found, and, as in other forms of
liver disease, a biopsy is needed for diagnosis.
                                           The Gastrointestinal System 147

   Antibiotics, cortisone, ursodeoxycholic acid, fluids, nausea control
and nutrition are components of successful treatment. Long-term treat-
ment to control inflammation may be needed.

Liver Shunts
Portal shunts are abnormal blood vessels that prevent the flow of blood
from the stomach and intestines to the liver. Blood must pass through
the liver for proper digestion and detoxification of materials absorbed
from the digestive tract. Cats with shunts can have seizures, behavior
changes and other neurological signs, especially after eating.
    Congenital (present at birth) shunts are the most common type.
Affected kittens tend to have retarded growth and development, in
addition to neurological signs. It is very apparent that something is
wrong in these kittens by the time they are six months old.
    Acquired shunts are infrequently seen in older cats, and occur as a
result of increased blood pressure around the liver due to other diseases.
    Routine blood tests do not specifically diagnose a shunt, but a bile
acids test suggests the problem. Ultrasound and hepatic scintigraphy (a
special test using radiation) aid in the diagnosis. Contrast portography
is another specialized test using dye and X rays to see the shunts.
    Most congenital shunts involve one blood vessel that can be surgi-
cally closed to treat the problem and redirect blood flow. Medical man-
agement to control toxins in the blood and underlying liver disease are
needed to treat acquired shunts. The prognosis depends on the age of
the animal and the number of shunts present.

The pancreas is an abdominal organ that aids digestion by creating and
releasing enzymes and secreting insulin needed for glucose absorption.
Bacterial infections, trauma and toxins can cause pancreatitis, an
inflammatory condition of the pancreas, but the cause is unknown in
90 percent of cases. Clinical signs are nonspecific and can include
lethargy, anorexia, vomiting, hypothermia, dehydration and abdominal
    Diagnosing pancreatitis in cats is a challenge.Abnormal levels of the
pancreatic enzymes amylase and lipase in the blood are not diagnostic,
the way they are in dogs. X rays, ultrasound and a special test for feline
TLI (trypsin-like immunoreactivity) suggest the diagnosis, but it cannot
be confirmed without a biopsy.
148 Guide to a Healthy Cat

    Treatment is focused on restoring hydration, maintaining the bal-
ance of electrolytes, controlling nausea, inflammation and pain, and pro-
viding nutrition. Most affected cats require hospitalization until they are
able to handle oral medications and eat on their own.

Cats, like dogs, have glands at the opening of their anus, located at five and
seven o’clock.These scent glands are expressed (emptied) when an animal
defecates or is very frightened. The material is normally brown and oily
with a foul, musky scent. Most cats never have problems with theses
glands, but occasionally they become impacted, infected or even abscessed.
    Because of their physical conformation, overweight cats tend to
have more problems emptying these glands. Some cats produce more
waxy secretions that tend to build up in the glands.Veterinary staff and
groomers can manually express them—most owners don’t want the
smelly and slightly uncomfortable (for the cat) job.
    Signs of anal gland problems are scooting or dragging the rear end,
excessive licking around the rectum and open sores under the tail. If
your cat exhibits any of these signs, get him checked out.
Chapter 15

Skin and Dermatology

The skin is the largest organ of any animal’s body; it comprises 12 to 24
percent of a cat’s body weight. It protects the cat and is responsible for
much of her external appearance. Changes in a cat’s skin and haircoat
can alert an owner to health and nutrition problems.
     There are many dermatological conditions that can affect cats, and
I’ll discuss some of the most common in this chapter. Some feline skin
conditions are contagious to humans and other animals, and others are
not. Most skin diseases look the same regardless of the cause, so testing
and observing how the cat responds to therapy are important to mak-
ing a proper diagnosis.

We treat itchy cats just about every day at my clinic. Some cats are mild-
ly itchy, and others are miserable and scratch themselves until they are
raw. Historically, fleas have been the most common cause of itchy cats,
but with improvements in the flea-control products available today, flea
infestations can be easily controlled. (The specifics of flea control are
discussed in Chapter 8.)

150 Guide to a Healthy Cat

                                                When you bring your
                                            itchy cat to a veterinarian,
                                            the animal should first have
   Allergens are foreign substances that    a full physical exam. The
   can cause an allergic response in        doctor should check the
   some animals. Antigens are foreign       cat for fleas and note the
   substances that cause the body to        distribution of the lesions.
   produce an antibody that responds
   exclusively to that antigen.             (A lesion is a change or
                                            injury to a body tissue that
                                            impairs the tissue or causes
                                            a loss of function.) The vet
should also review the cat’s history with you. Many diagnoses can be
made based on the animal’s age and history and the location of the
problem. If a diagnosis is not apparent based on this information, the
next steps would be to perform some diagnostic tests, such as:

     •   Skin scraping
     •   Wood’s lamp evaluation (a way to look for fungus)
     •   Fungal culture
     •   Microscopic evaluation of an imprint of the lesion
     •   Blood tests
     •   Allergy testing
     •   Hypoallergenic diet
     •   Skin biopsy

Allergies Can Cause Itchiness
An animal can be allergic to just about any substance in the world, so
allergies are a difficult problem to diagnose. Most cats with allergies have
itchy skin rather than respiratory signs. Allergies are suspected when
infectious causes of itchy skin and miliary dermatitis are ruled out.
(Miliary dermatitis is the term used by veterinarians to describe scabby,
crusty skin.The infectious causes of miliary dermatitis are parasites, fun-
gus and bacteria.)
     Eosinophilic granulomas are inflammatory lesions frequently seen
on cats that may be caused by allergies. The three types of lesions are
rodent ulcer of the lip, linear granuloma of the back legs and
eosinophilic plaque that can be found anywhere. Treatment for these
lesions is similar to that of other allergies.
                                                   Skin and Dermatology   151

    There are four types of allergies:

     1.   Inhaled allergies (atopy)
     2.   Food allergies
     3.   Flea allergies
     4.   Contact allergies

Inhaled Allergies
Inhaled allergies are generally managed rather than cured. If a specific
allergen can be identified and eliminated from the cat’s environment,
the manifestations of that particular allergy will go away. To identify
specific allergens, some type of allergy testing is needed.
     Veterinary dermatologists believe intradermal skin testing is the
most reliable way to test for allergies in cats.This test involves sedating
the patient, clipping the hair on one side of the chest and then inject-
ing tiny doses of antigens under the skin. The number of antigens
injected can vary, but it would not be unusual for 60 different sub-
stances to be included in a test.The veterinarian then examines the cat’s
skin for wheals—red, raised skin reactions. Each site that forms a sig-
nificant wheal is considered to be an allergen to that cat.
     Other allergy tests involve checking the blood for high levels of
specific antibodies to different allergens. There is usually a correlation
between antibody levels in the blood and allergic reactions, and specif-
ic antibodies can pinpoint specific allergens.
     If allergens are identified, a cat can receive allergy antigen injections
that desensitize her to the substances she is allergic to. Most cats receive
these “allergy shots” starting off weekly, and owners can learn to give
the injections themselves.The injections contain small amounts of anti-
gens that the cat is sensitive to, and this amount is slowly increased with
each injection.This hyposensitization therapy is about 70 percent effec-
tive, but it can take 6 to 12 months to see results.
     Treatment of atopy may include cortisone, given orally or by injec-
tion, antihistamines, fatty acids, antigen injections and antibiotics for
secondary skin infections.

Food Allergies
Cats with food allergies are usually itchy around their heads and ears.
Although intradermal skin tests and antibody blood tests can identify
some food antigens, the best way to diagnose a food allergy is with a
152 Guide to a Healthy Cat

food trial. In a food trial, a cat is fed an entirely new protein source for
four to six weeks. If the cat’s condition improves, the animal can be
challenged with different protein sources, offered individually, to find
out which one was causing the reaction. That protein source is then
eliminated from her diet.
    Lamb used to be considered a hypoallergenic food and was used in
food trials. Pet food companies all jumped on the bandwagon and start-
ed putting lamb in many commercially available products, so lamb is no
longer a unique protein source.A lamb diet may help some food-allergic
cats, but other less widely used protein sources are probably needed
    A successful food trial involves eliminating all treats and table scraps,
serving distilled water and feeding the test diet exclusively. Some of the
unique proteins currently being used are venison, duck and rabbit. Lamb
or ham baby food may also be used for a hypoallergenic food trial.

Flea Allergies
The most common allergy in cats is flea allergy dermatitis. For a cat
with this allergy, one flea bite can cause a reaction equal to 100 fleas.
Cats with flea allergy dermatitis are very itchy and have hair loss and
miliary dermatitis along their back, the base of their tail and behind
their back legs. The hair loss is due to self-trauma—incessant chewing
at the sites of flea bites.
    To diagnose flea allergy dermatitis, look for fleas or flea dirt (which
will look like tiny white and black specks—the white are flea eggs and
the black are flea excrement) on the cat and hair loss in the typical pat-
tern I’ve just described.The best way to look for fleas is by using a flea
comb to hunt for evidence.
    Some cats are so sensitive to fleas that they bite off every flea that
jumps on them and leave no trace of infestation. If a veterinarian does not
observe fleas but still suspects flea allergy dermatitis, he or she will treat
it.Treatment involves flea control (the once-a-month topical adulticides
work wonderfully) and, usually, cortisone to break the itch-scratch cycle.

Contact Allergies
These allergies are the least common in cats, but they can occur when
a cat touches an allergen.The reaction is usually localized to the site of
contact, but if the cat licks or rubs, the problem area can get bigger.
Topical treatment with a cream, ointment or spray can be a first course
of treatment, but oral or injectable medications will be needed if the cat
insists on licking the irritated spot.
                                                  Skin and Dermatology   153

    One potentially common contact allergy is with flea collars. Some
cats develop a rash or hair loss on their necks when a flea collar is placed
on them. The problem eventually goes away when the collar is
removed, but it can take weeks. Since new flea control products have
made flea collars obsolete, this problem is rarely seen anymore.

Although grooming is a normal cat behavior, some cats get carried
away and lick themselves until they are bald, red or create open sores.
This condition is called psychogenic alopecia, and it is diagnosed by
ruling out infectious and allergic causes of skin problems. I liken it to
people who bite their fingernails too short as a nervous, unconscious
habit.They don’t know when to stop!
    Treating this condition is a challenge, because it is difficult to break
the behavior pattern. Since cats cannot tell us how they feel and what
is bothering them, it is a hard to figure out why your cat developed this
habit and what to do about it.
    After any skin infection or irritation is treated, antihistamines or
antianxiety medications may be used for their calming effects. Bad tast-
ing sprays or gels will discourage licking, as will protective collars. If a
source of stress or environmental change can be identified, steps should
be taken to minimize their effect on the cat.
    Sometimes the problem is caused by boredom, and environmental
enrichment, combined with more play time, can help.

Feline acne is a fairly common problem that affects adult cats. Owners
often look at me incredulously when I diagnose their pet with this condi-
tion.They say,“My cat is too old to have acne!” or “All he eats is cat food.
Wouldn’t he have to eat junk food?” Just as in most cases of human acne,
more than one cause contributes to feline acne. Diet, hormones, allergies,
bacteria and cleanliness can all play roles in the development of acne.
    A diagnosis of feline acne is made during a physical exam.
Sometimes the owner has noticed draining sores on the cat’s chin, and
sometimes a veterinarian will discover acne lesions while performing a
routine examination. Blackheads and/or whiteheads are observed
around the lower lips or on the chin.These clogged pores can become
infected by bacteria and develop into a pustule. Pustules can burst and
drain, or can enlarge and cause discomfort.Acne usually looks worse to
the owner than it feels to the cat.
154 Guide to a Healthy Cat

     The onset of puberty does not trigger acne in cats, as it does in
humans, and cats do not grow out of acne. Acne is actually more com-
mon in older cats, most likely due to decreased grooming activity—the
chin is one of the areas a cat can have difficulty cleaning. Acne can
occur as a one-time episode, or it can be chronic and recurrent. It is not
contagious to other cats or to humans.
     A topical reaction to plastic food and water bowls has been impli-
cated as a cause of feline acne. Changing to glass, ceramic or stainless
steel bowls helps in some cases. Food oil residues that build up on food
and water bowl edges can also contribute to acne. If the animal’s chin
comes in continual contact with the dirty bowl, it makes sense that oily
buildup could clog the pores. Properly washing and drying your cat’s
dishes every day will help in many cases.
     Some cats immerse their chins in their food when they eat. I have
had owners inform me that simply serving their cat’s food on dispos-
able paper plates has cured the acne.
     In mild cases of acne, cleaning the animal’s chin daily with hydro-
gen peroxide is helpful. It will open up the pores, remove the black-
heads and clean out oils from the hair follicles.When more pronounced
inflammation and infection are present, clipping the hair and a veteri-
nary benzoyl peroxide scrub or cream is recommended. Oral antibiotics
may be needed for 10 to 30 days.
     Mucopurin (the brand name is Bactoderm) is a product that is use-
ful in some cases of feline acne. It is not currently approved for use in
cats, but it is an accepted treatment. Each patient responds differently to
topical treatments. In some cases, the treatment can cause severe dryness
and irritation, and should be discontinued.
     Corticosteroids are useful in relieving inflammation and decreasing
fatty secretions in the skin in some cases of acne, but if deep infection
is present, corticosteroids can exacerbate the infection. In more
advanced cases, vitamin A treatment may be necessary.Topical and oral
preparations of vitamin A are available, but side effects are possible.

Ringworm is actually a fungal infection and has nothing to do with
worms. The groups of fungi capable of causing ringworm are called
dermatophytes. Microsporum canis, or M. canis for short, causes the most
common type of feline ringworm. Fungal spores in the environment
that land on and grow on the skin transmit the fungus. Typically, cats
with ringworm are itchy and have red, scaly patches on their skin, along
with areas of hair loss.
                                                   Skin and Dermatology   155

Diagnosing Ringworm
Ringworm is contagious to humans and other animals, but the good
news is that just because you are exposed to it doesn’t mean you will
get it. If your cat has some sort of dermatitis, wash your hands after you
touch her and don’t allow the animal to sleep on your bed until a diag-
nosis has been made.
    Ringworm is tentatively diagnosed by a positive Wood’s lamp test.
A Wood’s lamp is a black light that causes shafts of hair infected with
the fungus to glow an apple-green color.
    To definitively diagnose ringworm, a dermatophtye test medium
(DTM) culture should be performed. Ringworm fungus will grow a
colony on the DTM, and the specific type of fungus can be isolated and

Treating Ringworm
It can take four to eight weeks to cure a ringworm infection. To suc-
cessfully treat ringworm, a multifaceted approach is needed. First, the
cat should be treated with oral antifungal medication. Weekly sham-
pooing and lime sulfur dips can make the skin more comfortable and
decrease the number of contagious spores on the cat.
    Giving ringworm-infected cats and nonaffected housemates the
oral flea control product Program is a safe ancillary treatment. Program
works to inhibit chitin, a protein in the skeleton of fleas and also in the
fungal organism.
    Ridding the environment of ringworm is almost impossible.
Frequently washing the cat’s bedding is helpful.Vacuuming can pick up
spores, and it is difficult to clean and disinfect the brushes on the vac-
uum cleaner to prevent further spread. Using a cheap hand vacuum and
then disposing of it is another option.
    Human ringworm looks like red, circular patches on the skin.These
areas are very itchy. Humans with isolated lesions respond well to topical
antifungal creams. Creams are not particularly effective on cats because
the cats often have multiple lesions, they lick off the cream, and it is hard
for the medication to get through the hair onto all the affected skin.
    Some cats have side effects from the medications used to treat ring-
worm, so a veterinarian should monitor the animal’s response to
treatment. After two weeks of treatment, the cat should be rechecked
and a CBC and/or liver enzyme test run to be sure the cat is handling
the medication without internal problems. Repeat DTM cultures
should be performed, and the cat should continue to be treated for two
weeks after the last negative culture.
156 Guide to a Healthy Cat

    If an animal is not treated completely, ringworm can quickly flare
up again. In multipet households it is usually necessary to treat all the
animals so that the infection is not passed back and forth between them.
    Previous infection with ringworm does not confer immunity, so it
is possible to have several episodes of infection within an animal’s life-
time. It can be a frustrating condition to treat, but if you stick with it,
the fungus can be controlled.

Mange is due to small bugs called mites.The two most common mites
that can affect cats are Otodectes cynotis and Notoedres cati. A type of fur
mite called Cheyletiella can also infect cats, and, rarely, a mite called
Demodex will as well.
    Mite infestations typically make a cat very itchy.These parasites can
be diagnosed by finding their presence on an ear swab, skin scraping or
tape impression examined microscopically.

Does Your Cat Have Ear Mites?
Otodectes cyanotis is the common ear mite. These mites can also infect
dogs, but they are not transmissible to humans. Ear mites can live for
short periods in the environment, but they must feed off a dog or cat.
The classic signs of an ear mite infection are head shaking, brown crusty
discharge from the ears and ear scratching.
     If you have an indoor cat who does not come into contact with
others, it is easy to cure an infection. If you have animals who go out-
side, they have the potential for re-exposure.
     There are effective over-the-counter treatments for ear mites, but I
recommend that if your cat has an ear infection, you have it properly
diagnosed by your veterinarian. Although ear mites are frequently
found in cats, they are not the only type of ear disease: Bacteria, yeast,
allergies and polyps can also affect the ears of cats. If you treat for ear
mites and there is another problem, your pet has to be uncomfortable
for a longer period of time.
     Some of the newer prescription medications used for ear mites are
milbemycin oxime (MilbeMite Otic), ivermectin (Acarexx) and
selamectin (Revolution). All are very effective.
     A positive diagnosis of ear mites is made using an otoscope that looks
deep into the ear and observing the mites crawling in the ear canal or by
examining an ear swab under a microscope and observing live mites or
                                                      Skin and Dermatology    157

mite eggs.There is a tendency to think of ear mites as not very serious,
and some cat owners think cats with ear mites do not need to be treat-
ed.This is absolutely untrue. Ear mites are extremely uncomfortable for
a cat—the itching and biting, plus the noise of the mites in the ear canals,
are a real torment. In addition, cats with chronic ear mite infections can
develop inflammatory polyps in their ear canals. They can also develop
blood blisters on their earflaps (ear hematomas) secondary to constant
rubbing. Ear mites must be taken seriously and treated promptly.

Can Your Cat Get Scabies?
Scabies is a type of mite infection caused by Sarcoptes scabei. This mite is
rarely found in cats, but a similar mite, Notoedres cati, is common. Notoedres
can jump on humans and cause temporary itchiness, but they cannot live
on our skin. On cats the mites tend to live around the face and ears, and
the cat develops a very crusty appearance.Affected animals are very itchy.
    A veterinarian will perform a skin scraping to diagnose this type of
mange and will be able to tell you within minutes if the parasite is
observed. A skin scraping involves using a scalpel blade to scrape small
amounts of hair and skin onto a slide with a drop of mineral oil. Mites
or mite eggs are then observed on the slide.
    Cats with mites are treated orally or injectably with the cattle
dewormer ivermectin, or topically with the cat-approved product
Revolution that contains selamectin. Bathing in pyrethrin shampoo
will kill mites on contact and aid in treatment.

This fur mite is more difficult to isolate and identify than other types of
mites. It is typically found on the trunk of a cat, and it causes hair loss, scal-
ing and itchiness.When Cheyletiella is suspected, an impression of a lesion
is made on a piece of transparent tape and then examined microscopically.
    Treatment for this mite is similar to that of other types of mange,
except that this mite can live in the environment for up to three weeks.
Using some type of environmental premises treatments that are effec-
tive against fleas will also kill these mites.

Demodex is a type of mange more frequently found on dogs, but it is
occasionally found on cats.This mite does not cause the intense itching
158 Guide to a Healthy Cat

characteristic of other types of mange. It can cause patches of hair loss
and redness.Your vet can diagnose the infection by observing the mite
on a skin scraping.

Cats have a fascination with bugs, and even if your cat lives indoors, she
will likely find every creepy crawly in your house. Many of these crea-
tures are harmless and your cat may eat them without a problem, but
others will bite and sting when threatened. Some beetles and bugs taste
bad and will cause drooling. Others will cause some minor gastroin-
testinal upset that passes within a few hours.
     Cats usually receive bites and stings on their noses and paws, since
they like to nose and bat at little creatures. If you notice swelling on
these areas, it may be due to an insect bite.
     Bee stings are painful and cause swelling on any animal. They are
uncomfortable and look bad but are only dangerous if the animal has
an anaphylactic reaction. In anaphylaxis, the allergic reaction that occurs
causes fever, redness and difficulty breathing.
     Antihistamines and/or cortisone can be used to decrease the
swelling and itchiness associated with any sting or bite.The earlier these
medications are used, the less swelling will develop.
     I always know when there is a spider in my house because my cats
go wild.They jump up the walls and cry in their desperate attempts to
catch it. Most spider bites are not a big deal, but cats are not very dis-
criminating and will hunt harmless and dangerous spiders alike.
Depending on where you live, brown recluse and black widow spiders
may exist, and these spiders can be quite dangerous.
     With their bite, poisonous spiders inject venom that can seriously
damage tissue. Initially, a bite wound may not be detected, but within a
day or so you’ll see an oozing wound with skin sloughing.These types
of wounds can take weeks to heal and should be treated promptly by a

Aside from mites, bacteria and yeast can infect the ear canals of cats. Just
like some people have greasy hair, some cats have greasy ears and pro-
duce excessive amounts of wax. Chronic irritation in the ear canals from
any cause can trigger the formation of benign inflammatory polyps. A
veterinarian needs to examine the cat’s ear canals with an otoscope and
analyze ear swabs, because all of these conditions are treated differently.
                                                   Skin and Dermatology   159

     Ear hematomas result when cats scratch at their ears too much,
regardless of the underlying disease. This scratching breaks small blood
vessels and causes a blood blister to form between the skin and the car-
tilage in the ear. This swells and makes the cat even more uncomfort-
able. Successful treatment must resolve the problem that caused the
itching, and surgically drain and repair the damaged ear flap.

There are a few different types of cancer that can affect the skin of cats,
but squamous cell carcinoma is the most common. Squamous cell carci-
noma (SCC) is a type of cancer that can be caused by excessive exposure
to sunlight, but it can also occur for no known reason.Aside from the ears
and face, SCC can occur in the mouth, on the body and on the feet.
     Other types of feline skin cancer include malignant melanoma, mast
cell tumors and cutaneous lymphosarcoma. Some can be cured by sur-
gery, while others cannot.
     In general, cats do not get many lumps and bumps on their skin, but
benign growths called sebaceous cysts are sometimes found. Any time
you notice a growth on the cat’s skin, you should monitor it and have
it checked out by a veterinarian. Increasing size, change in consistency,
spread to other locations or pain associated with a growth are all rea-
sons to have it examined.
     When your veterinarian examines a growth on the skin, he will
likely part the hair, assess the size and squeeze the tissue. Different types
of growths have different characteristics.
     To make a definitive diagnosis of any skin growth, some type of
biopsy is needed. Some veterinarians will perform needle biopsies and
cytology in their clinics.They will remove a few cells from the growth,
place them on a slide and examine them microscopically. Inflammation,
infection and fatty tissue are easily diagnosed this way. Other types of
cells may be sent to a lab for a clinical pathologist to review.
     Early detection and surgical removal can cure many cases of some
types of skin cancer. Cryosurgery (freezing the tissue) and laser surgery
are other methods for removing skin growths.
     We have all heard about the damage the sun can do to our skin, but
do we think about what it is doing to our pets? Fair-skinned people are
more sensitive to the effects of sunlight, and the same is true for cats.
Protruding areas with white hair and pink, unpigmented skin (such as
the ear tips and the end of the nose) are the most affected parts on cats.
Cats first become sunburned, then the skin is damaged and then squa-
mous cell carcinoma can develop.
160 Guide to a Healthy Cat

                       DEFINING SOME TERMS

    Cytology is a term used to describe the evaluation of cells under a
    microscope.This is different than a full biopsy with histopathology,
    which involves microscopic evaluation of tissue.The larger the sample,
    the more cells there are available for making an accurate diagnosis.
       If your veterinarian recommends a biopsy, the entire growth or
    just a piece may be removed. In general, it is a good idea to take as
    much tissue as possible the first time so that if a problem is found,
    the animal may not need another surgical procedure.

     If you notice red, inflamed skin or scabs on your cat that seem to go
away and then come back, you should have the area examined by a vet-
erinarian. It is not common for a cat to injure herself repeatedly in the
same area. Sores that don’t seem to heal may be indicative of skin cancer.
     Indoor cats are not at as much risk for SCC as outdoor cats, but many
cats like to lie in shafts of sunlight that shine in through the windows. If
the ultraviolet rays are not decreased by window shades or tinting, indoor
sunlight is still harmful.Waterproof sunblock can be applied to white ear
tips and pink noses to help protect skin against the sun. Keeping an at-
risk cat inside between 10 A.M. and 2 P.M., when the sun is strongest, will
decrease exposure to the most direct and damaging rays of sunlight.

Pyoderma is a bacterial infection of the skin, but it usually occurs second-
ary to another condition such as a wound, allergies or excessive grooming.
Pyoderma is a superficial infection that responds to antibiotics. Medicated
baths can help cool the skin, remove crusts and dry out the infection.
     Abscesses are deeper infections that start out as punctures or pene-
trating wounds, most often as a result of cat bites.The infection festers
and pockets of pus form under the swollen skin.To effectively treat an
abscess, the infected pocket must be surgically lanced and flushed, most
often under sedation or anesthesia.A drain is placed to prevent swelling
from again trapping infection under the skin, the surgical incision is
closed with stitches, and the cat is started on antibiotics. The drain is
removed in about three days, and the stitches in 10 to 14 days. A pro-
tective collar prevents a cat from chewing on her stitches or pulling out
the drain during the healing process.
Chapter 16

The Cardiovascular System

The cardiovascular system in a cat is comprised of blood, blood vessels
and the heart. All three components work in harmony to supply oxy-
gen and nutrients throughout the body and remove carbon dioxide and
metabolic waste products.
    A heart is an amazing organ that will continuously pump through-
out the entire lifetime of an animal.This adds up to more than 350 mil-
lion beats for a 13-year-old cat! Yet this powerful organ weighs less than
one-third of an ounce in an average cat.
    Heart disease is a common problem in humans, but fortunately cats
do not develop arteriosclerosis (hardening of the arteries), the leading
cause of heart attack in humans. However, cats can develop hyperten-
sion and other cardiovascular diseases.

Blood leaves the heart through arteries and returns to the heart through
veins. Arteries and veins channel into smaller and smaller blood vessels
that meet at capillaries. Blood leaving the heart is full of oxygen that is
sent out to nourish the body’s cells. Blood returning to the heart is full
162 Guide to a Healthy Cat

of carbon dioxide that must be removed. Nutrients from digested food
are absorbed by blood vessels in the intestines and liver and enter the
bloodstream. Waste products are produced by all cells, and are filtered
out of the blood by the kidneys and then made into urine.
    The path the blood takes as it is pumped through the heart is com-
plicated.The heart has four chambers with valves that regulate blood flow.
The upper chambers are called atriums and the lower chambers are called
ventricles.The major veins bringing blood to the heart are called the vena
cavas. Blood first enters the right atrium of the heart. It flows into the right
ventricle of the heart as it passes through the tricuspid valve. The right
ventricle contracts and sends blood into the pulmonary artery through the
pulmonary valve. Blood then goes to the lungs and becomes oxygenated.
    Oxygenation is the process through which red blood cells become
saturated with oxygen in the lungs. Oxygenated blood from the pul-
monary vein enters the left atrium. It then passes into the left ventricle
via the mitral valve.When the left ventricle contracts, blood is sent out
of the heart through the aorta and circulates throughout the rest of the
body.This entire cycle continues without pause, regulated by the pace-
maker (also known as the sinoatrial node), which is tissue that sends out
electrical impulses triggering the heart muscle to contract. Cats very
rarely have problems with the pacemakers of their hearts.
    The heart is covered by a sac called the pericardium. The pericardi-
um is not essential for life, but serves the important role of protecting
the heart against friction and inflammation. It stabilizes the heart’s posi-
tion in the chest cavity and maintains its shape.

Blood is the fluid that supports any animal’s body. It is composed of
three different types of cells:

     1. Red blood cells, which carry oxygen
     2. White blood cells, which fight infection
     3. Platelets, which are needed for clotting

     All of these cells must be present in sufficient numbers to keep an
animal healthy.
     Bleeding occurs when a blood vessel becomes damaged, and this
can happen inside or outside the body. Under normal circumstances,
platelets and clotting factors in the blood help to control bleeding, but
if a large blood vessel is damaged, these components may not be able to
form an adequate clot.
                                             The Cardiovascular System 163

How to Stop Bleeding
Cats are just like humans when it comes to bleeding. And, just like
humans, the first thing to do if a cat is bleeding is to apply pressure.
Adhesive bandage strips are not very useful on cats because of all of
their hair, so you’ll need to apply a more secure bandage. Care must be
taken when applying a bandage so that the right amount of pressure is
applied to the wound—enough to slow or stop the bleeding, but not
enough to stop the surrounding circulation.
    Applying ice or cold water to a bleeding wound is also useful.
Cold temperatures constrict the blood vessels so less blood is lost.
Another helpful hint is to keep the cat calm and stay calm yourself.
Cats are very attuned to their owner’s body language, and they will be
upset if you are. In turn, their blood pressure will rise and make the
bleeding worse.

How Much Blood?
Cats have about 30 milliliters of blood per pound of their body weight.
This means a 10-pound cat has about one and a quarter cups of blood
in his body. It also means a little blood loss can be a serious thing.
    If ice and a bandage do not stop bleeding, stitches are probably
needed to close the blood vessel and surrounding skin. A veterinarian
should do any suturing. Cautery (using chemicals or electricity to seal
a blood vessel) can be used in some bleeding situations, such as a bro-
ken toenail. Cautery is safe and easy, but it is not appropriate for all
types of wounds.
    Generally, if you see a few drops of blood come from your cat in an
isolated incident, there is no need for alarm. Often it is difficult to even
determine where the bleeding is coming from. Common sources of
bleeding are:

     •   Broken toenail
     •   Broken tooth
     •   Loss of a baby tooth in a young animal
     •   Rectal bleeding
     •   Any external wound
     •   Biting the tongue
     •   Bladder inflammation
     •   Ingesting rat poison (it contains a chemical that prevents blood
164 Guide to a Healthy Cat

    If you cannot isolate the source of the blood, or if there is more than
one episode of bleeding, consult your veterinarian. Bleeding can be a
sign of other diseases, and uncontrolled bleeding can lead to anemia.
    Cats have veins in their toenails, so if a nail is cut too short or bro-
ken accidentally, bleeding can occur.You can apply ice, cornstarch, pet
cautery powder or a styptic pencil (if you have one) at home, but if
bleeding continues or recurs, seek help from your veterinarian.
    Bruising is caused by bleeding under the skin. It can be difficult to
find bruising on a cat because hair covers most of the skin. If you notice
bruising and your cat has not sustained any known trauma, check with
your veterinarian. It could be a sign of a clotting disorder.

Anemia is a low red blood cell count.This is not something you would
likely be aware of, unless your cat had lost a significant amount of
blood.The two major ways anemia is classified are lack of red blood cell
production and loss of red blood cells through bleeding.
     A veterinarian may suspect your cat is anemic if the animal’s gums
look pale.A relatively simple test called a packed cell volume (PCV) can
be performed in a veterinary office in about five minutes, and will tell
the doctor the percentage of red blood cells in a blood sample. A feline
PCV should be around 37 percent. Once the value drops below 20 per-
cent, the situation is serious.
     A cat can die suddenly if his PCV drops below 15 percent. At this
percentage, his body could become starved for oxygen and a blood
transfusion must be considered.
     Cats who are anemic will often breathe in rapid, shallow breaths.This
is because their bodies are trying to get more oxygen, but there are not
enough red blood cells with which to transport it. Anemic cats are gen-
erally weak and have poor appetites because it is too much work to eat.

Low Red Blood Cell Production
Red blood cells are made in the bone marrow. The marrow is the tis-
sue at the center of bones where immature blood cells live and then
become stimulated to mature. Diseases and nutritional deficiencies that
affect the bone marrow will impair red blood cell production. Examples
of these are cancer, lack of iron, toxins, hormonal imbalances, kidney
disease, other metabolic diseases and drugs.
                                             The Cardiovascular System 165

Red Blood Cell Loss
Bleeding due to trauma is an obvious cause of red blood cell loss, but
red blood cells can be lost in other ways. One common and unfortu-
nate cause of anemia is an overwhelming flea infestation. Fleas feed on
the blood of cats, and if enough fleas are present, the animal can be
drained of blood and severe anemia can result. While fleas can cause
dangerous anemia in cats of all ages, they are especially dangerous to
young kittens, who have very small blood volumes. Cats and kittens can
die from flea anemia, but they can easily recover if flea control and sup-
portive measures are done in time.
    Another parasite that can cause anemia is called Hemobartonella felis,
also known as Mycoplasma haemofelis.This parasite gets into a cat’s blood
and causes destruction of red blood cells within the animal’s body.
Hemobartonellosis is also called feline infectious anemia (FIA). This
condition can be effectively treated with oral medications—if it is diag-
nosed in time.
    Autoimmune hemolytic anemia is a disease in which the cat’s body
no longer recognizes its own red blood cells.The immune system actu-
ally destroys its own red blood cells. This type of anemia can be life-
threatening if the process is not reversed. Jaundice is a clinical sign that
is often observed in cats with hemolytic anemia.

Diagnosing Anemia
The different types of anemia are diagnosed based on the cat’s history,
exam, blood tests and testing the bone marrow. Once a specific cause
or type of anemia is determined, steps are taken to correct the under-
lying problem and support the animal.
    Severely anemic cats need blood transfusions or blood extenders to
keep them alive. If the cause of anemia is not a problem with the bone
marrow, the animal will usually eventually be able to generate new
blood cells.
    There are in-clinic test kits or samples can be sent to a reference
laboratory to find out a cat’s blood type. Most veterinary hospitals have
a blood donor cat on the premises to use for transfusions. Modern tech-
nology has led to the production of a blood replacer that can be used
when typed blood is not available, but it carries risks and must be used
carefully in cats.
166 Guide to a Healthy Cat

                         FELINE BLOOD TYPES

    Cats have two main blood types: A and B. Almost all mixed-breed
    cats and most purebred cats in North America are type A.
    Abyssinian, Birman, British Shorthair, Cornish Rex, Devon Rex,
    Exotic Shorthair, Japanese Bobtail, Persian, Scottish Fold, Somali
    and Sphynx are examples of breeds that may have type B blood.

Congenital diseases of the heart do occur in cats but are not as com-
mon as they are in dogs. Any component of the heart can cause disease
if it is defective.The important components of the heart are:

     • The blood vessels leading into and out of the heart
     • The four main chambers of the heart
     • The valves between the chambers of the heart

    Cats born with bad hearts may not show any signs of problems.
Signs of heart disease are weakness, rapid or difficult breathing and
exercise intolerance. A veterinarian may suspect heart disease in a cat
after listening to the animal’s chest with a stethoscope and evaluating
the rate, rhythm and sound of the heartbeat.

The tricuspid and mitral valves are important in regulating blood flow
through the heart. In cats, deformities of these valves are the most com-
mon congenital cardiac malformations. Problems with the valves can
often be detected by cardiac auscultation. Auscultation means listening to
the heart and lungs with a stethoscope. A murmur—a squishing noise
that indicates there is blood leaking out of the valves when the heart
contracts—can be detected during cardiac auscultation. Instead of
forming a tight seal, blood escapes around the valve.
    The intensity or loudness of a heart murmur does not say much about
the severity of damage to the valves. Some kittens are born with murmurs
that they outgrow, much like human children. Other cats have murmurs
their entire lives that never get worse or cause heart disease. Unfortunately,
some murmurs progress and lead to congestive heart failure.
                                             The Cardiovascular System 167

    Murmurs are also extremely common in older cats. Over time, the
seal a valve forms may begin to leak. Leaky valves causing congestive
heart failure are much less common in cats than they are in dogs, where
this disorder is frequently observed.

Hormones and other chemicals within the body affect heart output.
Every cat owner has felt the pounding of their pet’s heart when he
becomes fearful. Adrenaline stimulates the heart to pump faster so the
animal can react more quickly to fear. I meet many fearful animals at
my veterinary clinic. Gentle stroking and calm words are often needed
to relax the animal so that heart auscultation can be done properly. But
I have to be careful not to relax the animal too much—if he really
relaxes, I can’t hear his heart over the purring!
    The tests that are performed to check the heart are:

     •   Auscultation
     •   Chest X rays
     •   Electrocardiogram (ECG)
     •   Heart sonogram-echocardiogram

    If an examination and auscultation cause a veterinarian to suspect
heart disease, the next diagnostic step is chest X rays. X rays show the
size, shape and location of the heart.They also show if there is fluid or
other problems in the lungs or chest cavity.
    An ECG may or may not be performed.This test measures the elec-
trical activity of the heart and can localize some types of heart disease.
The feline heart is relatively small, which makes diagnostic testing dif-
ficult, and electrocardiograph measurement in cats produces small trac-
ings that can be a challenge to interpret.
    Cardiac ultrasonography, or sonogram, is the most useful diagnostic
tool available to assess the heart’s function and appearance. X rays of the
heart tell veterinarians about the size and shape of the heart, but not
how the blood is being pushed through. Ultrasound enables the veteri-
narian to see and measure the individual heart chambers, valves and
major blood vessels. It can also document cardiac output and blood-
flow patterns. This information is crucial when diagnosing a problem
with the heart muscle. It can also be used to measure a cat’s response to
drug therapy.
168 Guide to a Healthy Cat

About 2 percent of cats are born with congenital heart defects. In addi-
tion to problems with the valves, which I have already discussed, there
may be holes in different chambers of the heart or strictures in blood
vessels leaving the heart. Some types of congenital heart diseases can be
surgically corrected and the cat can live a normal life. Other types may
be monitored throughout a cat’s life but never cause any clinical signs,
and still others may be life-threatening.
    Heart surgery is tricky in any animal, but due to the small size of
cats, it can be especially risky and expensive. Most congenital disease
involves defects in the structures of the heart, and these problems gen-
erally do not respond to medication.

The pumping action of the heart is achieved when the different cham-
bers of the heart constrict in a specific sequence (see page 162). The
heart itself is primarily composed of muscle tissue, and diseases can
affect this tissue.The medical term for heart muscle disease is cardiomy-
opathy.There are three main types:

    1. Dilated cardiomyopathy (DCM)
    2. Hypertrophic cardiomyopathy (HCM)
    3. Restrictive cardiomyopathy (RCM)

    Cardiomyopathy should be suspected in the sudden death of an
otherwise young, healthy animal. Often there are no obvious clinical
signs of heart muscle disease, so the problem may not be detected or
suspected before heart failure occurs.
    Echocardiography is needed to definitively diagnose any type of
cardiomyopathy. It is also used to monitor the progression of the disease
and the cat’s response to therapy. If your veterinarian does not have an
ultrasound machine, a specialist with a mobile unit may be asked to
come to the clinic or you may be referred to a specialty center that has
this equipment.

Dilated Cardiomyopathy
In dilated cardiomyopathy (DCM), the heart muscle stretches out and
becomes a thin, flaccid sack that is unable to contract properly. Blood is
not effectively pumped between the chambers or out of the heart.
                                              The Cardiovascular System 169

    A few decades ago researchers discovered that dilated cardiomyopa-
thy is most often caused by a dietary deficiency of the amino acid tau-
rine.This discovery led pet food manufacturers to add more taurine to
cat foods, which virtually eliminated this heart problem.

Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy (HCM) is currently the most common
type of heart muscle disease.The cause is unknown, but the disease may
be the result of a congenital defect or may be acquired during a cat’s life-
time. A cat with hypertrophic cardiomyopathy has thickened walls of the
left ventricle.This can also lead to thickening of other heart chamber walls.
     As the wall thickens, the size of the chamber decreases and less blood
is pumped through the heart.Turbulence and pressure builds within the
heart, aggravates the condition and makes the thickening worse.
     There are some drugs that can be used to reduce the stresses to the
heart and improve its function, but the disease cannot be cured. Cats
with HCM have shorter life spans because at some point the heart fails.
     A complication of HCM in cats is aortic thrombosis or saddle
thrombus.This is a blood clot that forms in the heart and then becomes
trapped at the splitting of the aorta, where this large blood vessel sup-
plies blood to the rear legs. The prognosis for a cat with an aortic
thrombus is not good.Treatment may dissolve the clot, but the under-
lying heart disease cannot be stopped and will progress.
     Cats with aortic thrombosis will suddenly become weak or para-
lyzed in their back legs due to the interrupted blood supply. This loss
of circulation is very painful to the animal. Less commonly, thrombi can
lodge and obstruct circulation to the front legs. A cat with a thrombus
will have cold, dark footpads and his toenails will not bleed where cir-
culation is lost.

Restrictive Cardiomyopathy
There are cats with heart muscle disease that does not classically fall
into either DCM or HCM. These animals are usually put in the cate-
gory of restrictive cardiomyopathy. Medications can be used to help
make the heart pump more effectively, but this disease will also progress.

For a long time, most veterinarians didn’t know that feline high blood
pressure, or hypertension, existed because they didn’t know how to
170 Guide to a Healthy Cat

check for it. Measuring blood pressure in cats is now becoming more
routine because veterinarians have fairly reliable equipment.
     In humans both systolic and diastolic measurements are used to
evaluate blood pressure. Systole is the highest blood pressure and occurs
when the heart contracts and pumps blood. Diastole is the lowest pres-
sure and occurs when the heart relaxes and fills with blood. Systolic val-
ues are considered the most sensitive indicator of feline hypertension,
and values over 180 mm Hg are considered too high.
     Hypertension is usually found in older cats who are also affected
with kidney disease and/or hyperthyroidism, but it can also be a pri-
mary disease. If the heart sustains long periods of high blood pressure,
it can weaken. Hyperthyroidism can lead to overstimulation of the
heart muscle, which also wears the muscle out prematurely and leads to
     To control blood pressure in cats, the underlying disease must first
be controlled. If no underlying disease is found, drugs are available to
control blood pressure. Lower sodium diets are also useful.

If you have a dog, you may be familiar with heartworm disease. The
heartworm parasite Dirofilaria immitis is transmitted by mosquito bites,
which inject the immature stage of the worm into an animal’s blood.
These larvae develop into adult worms that like to live in the heart or
pulmonary blood vessels. Heartworm disease can cause breathing prob-
lems and damage to the heart.
    Cats have natural resistance to heartworms, but they can still
become infected.There is a higher risk of infection in areas where there
are more mosquitoes carrying heartworm larvae. With no exposure to
infected mosquitoes, cats cannot get heartworm.
    Preventive medication is available to protect cats who are at risk for
heartworms.Ask your veterinarian about the risk of heartworm in your
area, and then decide if preventive care is needed.

Diagnosing Heartworms
Heartworms should be considered as a possible diagnosis for cats who
have signs of heart disease, vomiting or asthma and live in a high-risk
area where mosquitoes are present. Blood tests that look for antigens to
the parasite and antibodies the cat produces against the parasite are use-
ful in making a diagnosis. Heartworms can be observed on an ultra-
sound of the heart.
                                             The Cardiovascular System 171

    Dogs infected with heartworms have many adult worms in their
bodies, whereas cats may only have one to three worms. Smaller worm
loads in cats make diagnosis more difficult.

Treating Heartworms
Sudden death can occur in cats infected with heartworms due to
embolization. This is because clots (emboli) caused by the worms can
lodge in the heart, brain or lungs and block blood flow. There are
potential complications regardless of the treatment used.
    The toxicity and side effects of treatments that kill adult heart-
worms (adulticides) in cats are considered more of a risk than living
with the parasites for cats who have mild clinical signs. Depending on
their location in the heart, worms can sometimes be removed with spe-
cial forceps or brushes. Adult worms usually only live for about two
years in cats, so if the clinical signs they are creating can be controlled
medically, adulticides are not used. Conservative medical treatment
consists of using cortisone to control the inflammation caused by the
worms in the airways.
Chapter 17

The Musculoskeletal

A cat’s body is shaped the way it is because of the cat’s musculoskeletal
system, which is comprised of the bones, the muscles and the tissues
that connect them.The skeleton supports the structure of the cat’s body
and protects some internal organs. The muscles enable the body to
move by controlling direction and range of motion. Cartilage, tendons
and ligaments hold it all together.
     Cats carry 60 percent of their weight on their front legs, so during nor-
mal activity less stress is placed on the back legs. Jumping up initially puts
all the stress on the back legs, and jumping down puts all the stress on the
front legs.These factors should be kept in mind when dealing with injuries.
     House cats are fairly sedentary animals, but they have bodies that are
designed for hunting and stalking. Cats are extremely flexible and quick
(unless they are overweight), and they are able to perform some very
athletic feats. It is not uncommon to find cats perched on top of
dressers, on the high shelves of bookcases, or even climbing up on roofs
of houses. This chapter will address some of the more common prob-
lems of the bones and muscles of cats.

                                                 The Musculoskeletal System       173

“Fluffy doesn’t jump up on my bed the way she used to. Could she have
arthritis?” “Sly has a hard time walking after he’s been asleep. What
could this mean?” Questions such as these are commonly asked at my
clinic. I tell owners that, just like humans, cats can develop arthritis.
     Classic osteoarthritis (the medical term is degenerative joint disease, or
DJD) can develop in cats. Arthritic animals have changes in the bones
of their joints that cause discomfort and can decrease their range of
motion.Your vet may suspect arthritis based on a physical examination
and pain in the joints, but an X ray is needed to observe the character-
istic changes and confirm the diagnosis.
     The earliest clinical sign detected in cats with arthritis is lameness.
As this gets worse, the cat becomes reluctant to perform certain move-
ments or activities, and there is apparent stiffness or pain. Stiffness may
become more pronounced after periods of rest, as the disease progress-
es. Affected joints may look and feel enlarged and swollen, and the
range of motion becomes restricted.
     There are some uncommon types of arthritis where inflammation
of joints occurs but bony changes do not. This can occur with joint
infection, trauma and immune-mediated conditions.

Can You Prevent Arthritis?
Once arthritis has developed it cannot be cured, and small changes do
occur as a normal part of aging. Signs include:

     •   Stiffness after sleeping
     •   Inability to jump up on things
     •   Lameness
     •   Problems getting into and out of a litter box

                              HIP DYSPLASIA

    Hip dysplasia is a type of degenerative joint disease most commonly
    seen in dogs, but it is also seen in cats. It is a disease of young animals
    who are born with poor conformation of their hip joints. Rubbing
    occurs between the bones in the hip joint and arthritis follows.
174 Guide to a Healthy Cat

                         OTHER POSSIBILITIES

    If a veterinarian suspects arthritis but X rays don’t support the diag-
    nosis, it is likely that nerve pain rather than bone or muscle pain is
    the problem.You may need a referral to a veterinary neurologist
    and additional diagnostic tests, such as a special X ray of the spine,
    called a myelogram, or an MRI.

     Joints are made up of bones that have cartilage on their ends. The
cartilage cushions the bones and decreases friction. Each joint has a
small amount of fluid in it called synovial fluid that lubricates the car-
tilage and adds more cushioning. In an arthritic joint, the cartilage
becomes rough, the joint fluid becomes thick and abnormal calcium
deposits are formed at the ends of the bones.
     You can decrease the risk of arthritis for your cat by feeding her
a good diet that ensures proper bone growth and development.
Controlling a cat’s weight is very important because the heavier a cat is,
the more stress is placed on her joints. Keeping a cat indoors will lower
the risk of trauma to bones and joints, and trauma can lead to arthritis.
Cold temperatures make joints ache more, so allowing an older animal
with arthritis to sleep on a padded, warm surface can help make the cat
more comfortable.

Don’t Take Two Aspirin . . .
Cats are very stoic animals, so it is difficult to assess how much pain an
arthritic cat is in.The worst thing you can do is try to treat pain with-
out consulting a veterinarian. Over-the-counter anti-inflammatory and
pain medications for human should never be given to a cat. If you think
that your cat has arthritis and discomfort, consult your veterinarian to
find out what safe medical treatments exist.
    Medications used to treat arthritis may include children’s aspirin or
other nonsteroidal anti-inflammatory drugs (NSAIDs), cortisone and
nutritional supplements. One 83-mg children’s aspirin can be safely
given once every three days—but only under the supervision of a vet-
erinarian. Any other NSAIDs, such as carprofen and ketoprofen are
much more toxic and are prescribed much less frequently.
    Cortisone is often used in cats to reduce pain and inflammation.
Owners are sometimes reluctant to use corticosteroids because, they
                                              The Musculoskeletal System   175

have heard of the problems these drugs cause in humans. Cats are
much less sensitive to the effects of these drugs and most show no side
effects. Corticosteroids can be given orally or by injection. Whenever
this class of drugs is used, the lowest dose that controls the symptoms
is best.
    Glycosaminoglycans (GAGs) have also been used in the management
of arthritis.They are available as injectable drugs or as oral supplements.
Various manufacturers make glucosamine nutritional supplements that
contain slightly different forms of the chemical. GAGs do not provide
immediate relief from pain or inflammation; rather, GAGs improve the
consistency of the cartilage and joint fluid so that joint friction is reduced.
This process takes from three to six weeks, because that’s how long it
takes to remodel the tissue. In many cases cats can be managed with these
products alone.
    Other nutritional supplements helpful to some cats are fish oils,
antioxidants (vitamins E and C and zinc) and MSM (methylsul-
fonymethane). Make sure you give your cat the right dose, because sup-
plements can create problems when a cat gets too much.
    Helping a cat with arthritis to get up and down to familiar spots is
beneficial.This can be done by physically placing the cat or by using a
step or stool to help the cat reach her destination. It is also helpful to
be sure food and water bowls are easily accessible, and that the animal
is able to get in and out of her litter box.

                          GLUCOSAMINE AND

    Glucosamine and chondroitin sulfate are nutritional supplements
    that may help humans and animals with arthritis.These products can
    improve cartilage and joint fluid but are not anti-inflammatories.
    There are hundreds of products available that contain these ingredi-
    ents, but a study performed at the University of Maryland Pharmacy
    School and published in the Journal of American Nutraceutical
    Association in Spring 2000 showed that 84 percent of products tested
    did not meet their label claims.The same study looked at absorption
    of chondroitin sulfate and found much variability.
       The bottom line is use a product that guarantees its analysis and
    has research data to back up its claims.This is true for any supple-
    ments, since, unfortunately their manufacture and marketing is not
    well regulated.
176 Guide to a Healthy Cat

Any bone in the body can break if enough force is applied to it. Cats
break bones when they are hit by a car, fall from a height, get shaken
by a dog or larger animal, get caught in a garage door or even get
stepped on by their owner. The bad news is that fractures are painful
injuries, but the good news is that cats generally heal well.
    There is significant pain and swelling associated with a fracture. A
veterinarian may be able to feel the ends of the broken bone or hear
abnormal cracking sounds, but an X ray is always needed. At least two
views of the bone are necessary to properly evaluate the fracture and
assess options for setting and immobilizing it.Aside from diagnosing the
fracture, it is necessary to evaluate the surrounding tissues to see if there
is other damage.
    Some fractures heal adequately without surgery or a cast, such as
pelvic fractures that don’t involve the hip joints. If there is no damage
to the nerves, hip joints or other organs, cats with pelvic fractures can
be confined and treated with supportive care, and may be up walking
and functioning on their own within two weeks. This is quite a feat,
considering that humans with the same injury can be bedridden for

Putting the Pieces Together
The location of the fracture and the number of pieces of bone involved
will determine how easy or difficult the repair will be. Many veterinar-
ians do basic orthopedic procedures in their hospitals, but complicated
injuries may need to be referred to a board-certified veterinary sur-
geon. Surgeons usually have more experience and equipment available
for good repair of fractures. The equipment used to repair bones

     •   Surgical wires
     •   Stainless steel pins
     •   Bone plates
     •   Bone screws
     •   External fixation apparatus
     •   Casts
     •   Splints
                                            The Musculoskeletal System   177

Is Amputation an Option?
There is an art to fixing leg fractures, but sometimes the damage is so
severe or expensive that amputation may have to be considered. It is an
idea that may be hard to accept, but cats with three legs can do
extremely well and lead normal lives. It may take cats a few weeks to
figure out how to make the remaining limbs work together, but after
awhile you both may forget that the animal is handicapped.
    Amputation may also be necessary when tumors affect bones or tis-
sues of the limbs.This is done to prevent the spread of disease and cre-
ate surgical borders that are free from cancerous tissue.

The Healing Process
The younger the animal, the quicker the bones will heal. Complete
healing can take 6 to 12 weeks, depending on the severity of the frac-
ture. During this period the cat should be kept indoors and her activi-
ty restricted. It’s hard to restrict a cat, but lifting her up and down and
carrying her up steps is helpful. It may be necessary to confine her to
one room if you are unable to get the cat to rest.
    Follow-up X rays will show how the bone has healed. Even if heal-
ing is not perfect, pet cats will do well since they don’t have to hunt to
feed themselves and they can stay indoors and be protected. Sometimes
when orthopedic hardware is used to immobilize the bones, it needs to
be removed once the bone has healed.This may involve tranquilization
or sedation.

Sometimes cats have soft-tissue injuries, including sprains and strains.
Sprains are twisting or pulling of ligaments, which are the tissues that
connect bones. Strains are twisting or pulling of tendons, which are the
tissues that connect muscles to bones.
     Soft-tissue injuries can be just as painful and swollen as fractures.To
diagnose a sprain or strain, a veterinarian will first examine the cat and
manipulate the affected limb, joint by joint, to find out the exact loca-
tion of the injury. If pain and/or swelling can be isolated and a joint is
involved, the stability of the joint will next be evaluated.
     An X ray of a sprain or strain may show swelling, but it won’t show
the specific tissues involved or the amount of damage. This is because
178 Guide to a Healthy Cat

X rays don’t show much contrast between different soft-tissue structures.
If a significant number of ligaments around a joint are seriously dam-
aged, however, the bones may not line up as expected and this will show
on an X ray.
     Cats don’t know when they need to rest, so it can be difficult to
keep an animal confined so that healing can occur. Pain relievers can be
used, but there may be a trade-off between pain control and activity:
Cats may need to feel some discomfort so that they will take it easy.
     You can place a limb in a sling or put a support wrap on a soft-
tissue injury, but often the cat is more bothered by the wrap than by the
injury. Cats are free spirits who hate having their movement restricted
in any way, so it may be better to do nothing.
     It usually takes from two to six weeks for a sprain or strain to heal,
and once a joint has been damaged, it is never the same again. It is easy
for injuries to recur after a sprain or strain, because the scar tissue that
forms during healing is not as strong as the original tissue.

Sports fans may be familiar with the anterior cruciate ligament (ACL),
which is one of the main ligaments that hold an animal’s (or a person’s)
knee together.Tearing it is a common injury of football players.
    Even though most house cats are agile athletes, they can get their
leg stuck or land on it in an awkward position and sprain or tear their
anterior cruciate ligament. Depending on the severity of the injury, the
cat may or may not be able to walk on a leg with cruciate damage.
    A veterinarian can determine if the ACL has been injured by per-
forming an anterior drawer test.This involves measuring the amount of
laxity present when the knee is moved forward and back.The more lax
the movement, the more damage the ligament has sustained.
    Most ACL injuries in cats will heal if the animal is put on injured
reserve for two to four weeks. If, during this time, adequate healing
does not occur, surgery may be needed to stabilize the knee.

Kittens can be born with a variety of skeletal problems. Some give them
an unusual appearance, and others affect the way they function. If func-
tioning is a problem, surgical correction is necessary.
                                            The Musculoskeletal System   179

    Some breeds of cats developed because they were selectively bred
to emphasize conformational differences of certain bones. The most
popular of these is the Persian, with its round skull and flattened,
brachycephalic face. Burmese and Himalayans are other breeds that
share the “pushed-in nose” look. (You may think of the skull as one
unique bone, but this is not the case. Cats have 29 different bones that
make up the skulls.)
    Different numbers of tailbones characterize some breeds. Most cats
have between 18 and 20 caudal vertebrae that make up their tails. Manx
cats have far fewer, and are considered “rumpys” or “stumpys,” based on
how much of a tail they have. Their lack of tail is due to an inherited
dominant trait. Japanese Bobtails and Pixie Bobs are other breeds with
shorter-than-average tails.
    Another tail defect is a congenital kink. Many cats are born with
kinks in their tails, and this is considered a recessive trait.The kink can
come from trauma at birth (or immediately following), or it can just be
the way the kitten turned out. Most owners think the kinky tail gives
their cat character.
    A polydactyl cat is one who has extra toes, and this trait results from
an autosomal dominant gene. Domestic cats have 19 pairs of chromo-
somes. Eighteen pairs are autosomal, meaning nonsex-determining chro-
mosomes, while the last pair are the sex-determining sex chromosomes.
    Some cats have extra toes on their front feet and some have extras
on all four feet. Polydactyl cats need more help keeping their nails short
because the extra nails usually do not get worn down during normal
activity. Unclipped nails that
continue to grow will actually
penetrate into the footpads,
causing pain and infection.
    Humans can also be born
polydactyl. Throughout history,
people with extra fingers were
considered to be witches. Anne
Boleyn, one of Henry VIII’s
wives, had six fingers on one
hand. She was decapitated fol-
lowing accusations of adultery,
before a strong witchcraft case
could be made against her.             Polydactyl cats can be awfully cute.
180 Guide to a Healthy Cat

Hip dysplasia can occur in cats, but because most cats, unlike dogs, don’t
do a lot of running, they live fairly comfortably with this condition. If
pain or problems progress, a surgical procedure called a femoral head
osteotomy can help keep the hip bones from rubbing and worsening
the condition.This surgery is also used when a cat dislocates her hip as
the result of an injury and it will not stay back in place.
    Pectus excavatum is a congenital deformity of the rib cage. Kittens
with pectus have a flattened chest cavity and their breathing can be
impaired. Some cats grow out of this condition, but for others, breath-
ing worsens and a surgical procedure that pulls out the ribs is needed
to correct the defect. This defect may be seen in any cat, but certain
lines of Bengal cats seem to have a higher incidence.
    Some cats are born with a luxating patella, which is a kneecap that
pops out of joint. This condition is usually due to an abnormally shal-
low groove in the femur (the long bone the kneecap sits on) but can also
result from trauma. Cats with luxating patellas may have an intermit-
tently collapsing rear leg. They may hop temporarily until the kneecap
pops back into place. A surgical procedure that deepens the groove and
tightens the knee joint can successfully correct this problem.
Chapter 18

The Endocrine System

The system of glands that secrete hormones is the endocrine system.
Hormones are chemicals that produce an effect on another part of the
body. Some hormones have very specific functions, while others affect
many other body systems in a subtle manner.
    There are many different hormones produced throughout a cat’s
body, but there are only a few that cause common imbalances or prob-
lems. Hormones are usually transported through the blood to their tar-
get tissues.The main endocrine glands that produce hormones are the
pituitary, thyroid, parathyroid, pancreas, adrenals and ovaries or testes.

Cats have two thyroid glands located on their lower neck. A normal
thyroid gland is difficult to palpate during a physical exam but may be
detected if it is enlarged. Hyperthyroidism is the most common
endocrine abnormality seen in cats. This condition is usually caused
by a benign growth, known as a thyroid adenoma, that overproduces
thyroid hormone.
    Cats nine years old and up are most affected by hyperthyroidism.
While it is common for cats to be hyperthyroid, it is common for dogs
182 Guide to a Healthy Cat

to be hypothyroid, which means they have underactive thyroid glands.
Humans can have thyroid imbalances either way.

Signs of Hyperthyroidism
The thyroid gland produces hormones that have many different func-
tions.Their main purpose is to regulate metabolism.Thyroid hormone
affects every part of the body to some degree, but its major effects are
on the heart, skin and gastrointestinal tract.
    The common clinical signs associated with hyperthyroidism are:

     •   Weight loss
     •   Increased appetite
     •   Increased thirst
     •   Increased urination
     •   Increased heart rate and possibly irregular heartbeat

     Owners might notice these changes in their cat, but often they are
discovered during a routine physical examination and discussion with a
veterinarian. If a veterinarian suspects your cat is hyperthyroid, she will
want to perform some blood tests.
     Blood tests are good for pinpointing hyperthyroidism and for dif-
ferentiating the disease from other metabolic imbalances. If the thyroid
hormone level is not out of the normal range on a basic test, but clin-
ical signs suggest a problem, the veterinarian may want to perform
either a T3 suppression test or free T4 by equilibrium dialysis.A T3 sup-
pression test is a blood test that looks at whether the thyroid gland
reacts normally to the administration of supplemental thyroid hor-
mone. A normal cat’s T4 values will go down in this situation, but a
hyperthyroid cat’s will not. Free T4 by equilibrium dialysis is a blood
test that is felt to more accurately evaluate T4 levels. These tests are
straightforward but not without some false positives.
     Finally, another test called a technicium scan may be required.This
test highlights the thyroid gland through special imaging and shows if
there is overactive tissue.

Treating Hyperthyroidism
Uncontrolled thyroid disease will lead to many problems. Aside from
poor general condition and a slow wasting process, a hyperthyroid cat
can develop serious heart disease. Heart disease occurs because the heart
                                                The Endocrine System   183

is under too much continual stimulation and the muscle begins to
weaken. High blood pressure can also result from hyperthyroidism.
    There are three accepted treatments for hyperthyroidism:

    1. Drug therapy
    2. Surgery
    3. Radioisotope treatment

     Each treatment has its pros and cons. A veterinarian should discuss
all the options and help you decide on the most appropriate course,
based on your individual situation. Once a cat becomes hyperthyroid,
it will always be hyperthyroid unless the overactive tissue is removed.

Drug Therapy
This is the least expensive option for treating hyperthyroidism, and usu-
ally means giving the cat methimazole twice a day. Most cats tolerate
this drug extremely well, but others can have side effects such as vom-
iting, bone marrow suppression and dermatitis.
    To monitor for side effects and the effectiveness of the treatment,
a cat is started on a low dose of medication and then evaluated two
weeks later. At that time it is advisable to do a red blood cell count to
look for bone marrow suppression. Based on the results, the cat may
stay on the same dose or the dose could be modified. Cats are gener-
ally checked every two weeks until the thyroid level is in the normal
    Medical treatment will continue the rest of the cat’s lifetime. It is
not the end of the world if an owner misses giving a dose every now
and then, but to be properly regulated, the cat must receive medication
regularly. Long-term medication costs and repeated follow up testing
will add up over years, so don’t disregard other treatment options.

Take Them Out
Surgical removal of the thyroid glands can be a successful treatment.
Both glands are usually removed because it is difficult to tell if one or
both glands are affected without looking at the tissue microscopically.
The surgery involves the tissues of the neck and no body cavities are
opened. Once the thyroid is removed, it will not grow back. Some
glands have malignant tumors called thyroid carcinomas, which are dis-
covered when a biopsy is performed.
184 Guide to a Healthy Cat

    One risk of surgery is that the parathyroid glands, which are locat-
ed close to the thyroid glands, can be accidentally removed at the same
time.The parathyroid glands are responsible for calcium balance in the
body. Other risks of surgery are that a cat’s thyroid level can become
too low if both glands are removed, and if overactive thyroid tissue is
located outside the gland itself, it will remain in the body and contin-
ue to cause problems.
    If an owner does not want to medicate his cat, surgery is a reason-
able option.There is not a long recovery period, but hormone and cal-
cium levels should be checked postoperatively, and supplementation
may be needed for the cat’s lifetime.

Nuke Them Out
Radioisotope therapy involves treating the cat with radioactive iodine.
The thyroid gland naturally takes up iodine from the blood and con-
centrates it, so the radioactive iodine gets to its target tissue easily.The
radioactive isotope destroys the abnormal tissue.
    Radioisotope therapy is considered superior to surgical removal and
medical treatment because:

     • It’s a one-time treatment
     • The overactive tissue is selectively destroyed, rather than
       removing the entire gland
     • There is no risk of anesthesia
     • The parathyroid glands are untouched

    The disadvantages are:

     • Significant expense
     • Hospitalization for approximately 3 to 14 days (depending on
       local environmental regulations) while the radiation is elimi-
       nated from the cat’s body
     • Some cats develop kidney disease when their thyroid level
       drops too low too quickly

    Radioactive iodine treatment is only available at special veterinary
hospitals with the proper facilities. Depending on where you live, this
mode of treatment may not be easily available. If you have a hyperthy-
roid cat, discuss all of the options with your veterinarian.
                                                  The Endocrine System    185


    Iodine is an essential mineral for animals, including humans.There
    was a time when iodine deficiency was common in humans, and
    people developed goiters (swollen thyroid glands) because they did
    not get enough in their diets.Today, good old table salt is iodized
    and provides iodine to the body.

Diabetes mellitus is a disease in which glucose in the blood cannot be
properly taken up and used by the cells of the body.This is usually due
to a lack of insulin, a hormone responsible for transporting glucose into
cells.The pancreas is the organ that produces insulin.
     Diabetic cats eat but are essentially starving because the glucose in
their blood cannot be used for energy.As this process continues, the ani-
mal’s body condition declines. Muscle and fat are broken down for
energy—in essence, the body is eating itself—because the body is not
obtaining glucose from food.

Signs of Diabetes
The classic signs of diabetes are increased thirst, increased urination and
weight loss. Other signs that can be associated with the disease are blad-
der infection (caused by too much glucose in the urine), abnormal pos-
ture (cats get a nerve disorder that makes them walk on their heels), loss
of muscle tone and shock.
    There are some drugs that can cause diabetes mellitus as a side
effect. Megestrol acetate is the most common culprit, but some cats are
sensitive to even routinely used corticosteroids. (Megestrol acetate, a
synthetic progestin, is currently not used often in feline medicine. It
can be used for behavior problems, to suppress estrus and for some der-
matological conditions, although it is not a first-choice treatment.)
Drug-induced diabetes is usually a temporary condition, but it may
need treatment for months.
    Overweight, older cats are at greater risk for developing diabetes.
The disease is diagnosed by finding high levels of glucose in the blood
and urine of the affected animal. If the disease has been present but
undetected for awhile, other metabolic imbalances may also be present.
186 Guide to a Healthy Cat

                      TWO TYPES OF DIABETES

    There are actually two major types of diabetes in animals.
    Diabetes mellitus is the disease with which most people are
    familiar. Diabetes insipidus is a less common disease involving
    water balance in the body.

     Hyperglycemia is the medical term used to describe higher-than-
normal levels of glucose in the blood. Although this situation is usually
attributed to diabetes, cats who are stressed will have high blood glu-
cose levels.Truly diabetic cats will have significantly higher blood glu-
cose levels than stressed cats. If there is any question, a blood test that
measures serum fructosamine can differentiate between the two.

Treating Diabetes
If left uncontrolled, diabetic cats will starve to death, but the progres-
sion may take years. Each veterinarian has her own way of treating dia-
betic cats. The choices for treatment are insulin given by injection or
oral hypoglycemic agents (drugs that lower blood glucose by making
cells more sensitive to insulin), along with a change in diet.The prob-
lem with the disease in cats is that cats metabolize some drugs very rap-
idly, and insulin’s effects are variable.
     Most cats need insulin injections twice a day, ideally 12 hours apart,
to begin good blood glucose regulation. Insulin is given by subcuta-
neous injection, and giving insulin injections is relatively easy if you are
willing to learn.
     Although most diabetic cats will require insulin for their entire lives,
some are transient or temporary diabetics, and their need for insulin will
come and go. Even when regulated, diabetic cats should be examined
and have their blood glucose monitored at least every six months. If
there is ever any doubt as to how a diabetic cat is doing, or if the animal
is not eating, it is always better to skip an injection rather than to keep
giving insulin. Too much insulin, or insulin given without food, can
cause hypoglycemia, which can be a life-threatening condition.
     My personal experience using oral hypoglycemic agents has been
variable, with effective results obtained after first starting treatment with
insulin. I have had poor success with initial glucose regulation on oral
medication alone. If a cat is doing well on insulin, the treatment is
                                                 The Endocrine System   187

continued. If good regulation is not achieved with insulin, then I add
in an oral agent. The combination typically lowers the amount of
insulin needed. If a cat seems to need less insulin, I will try to maintain
the patient on oral treatment alone. Managing this disease requires a
balancing act.
     Diet can play a role in managing diabetes, but it can also be a cause.
Since cats are naturally carnivores and metabolize protein for glucose, it
is thought that dry cat foods that contain a high percentage of carbohy-
drates may predispose certain cats to developing diabetes.Although older
research indicated that fiber added to a diet helped control blood glucose,
newer studies show that higher protein and lower carbohydrate diets may
be more ideal for diabetic cats. Fiber is actually a type of carbohydrate.
     Canned foods tend to contain higher protein levels than dry.There
is a specially formulated high-protein diabetes diet that comes in both
canned and dry forms, but most canned kitten food contains similar
protein levels.Whichever diet is chosen, weight management is anoth-
er important aspect to controlling diabetes.

One of the reasons spaying is recommended for cats is that intact female
cats are at risk for pyometra, a uterine infection. Pyometra is a serious
condition in which the uterus becomes distended and filled with pus.
If the infected organ ruptures, pus can spread all over the abdominal
cavity and cause peritonitis—a potentially fatal infection of the
    Fortunately, most pet owners spay their cats at an early age and do
not have to worry about this problem. Experienced cat breeders are
aware of the condition and monitor their queens for the telltale sign of
creamy-colored vaginal discharge.
    Cats with pyometra can have fever, lethargy and poor appetite. If a
veterinarian suspects pyometra, she may confirm the diagnosis by pal-
pating the abdominal cavity and finding an enlarged, fluid-filled uterus.
If this is not found, she may do a blood test to look for a high white
blood cell count. Other useful tests are vaginal smears to look for white
blood cells (the components of pus) and bacteria, and X rays or ultra-
sound, which can be more sensitive for identifying uterine enlargement.
    Unless there is an exceptional reason to keep a female cat intact, the
best treatment for a cat with pyometra is spaying her. The surgical
procedure is more complicated than a routine spay surgery because
the infected uterus is fragile and must be handled carefully to prevent
188 Guide to a Healthy Cat

problems. A cat with pyometra is usually not in prime health, because
she has been fighting an internal infection. Under these circumstances,
close monitoring and strong supportive care is needed.
    If an owner does not want to have the cat’s uterus and ovaries
removed, medical treatment is an option. Antibiotics and drugs called
prostaglandins are used to treat the infection and shrink the uterus.
Prostaglandins stimulate uterine contraction, but they can also cause
general cramping and discomfort.
    Cats who have had pyometra have a high chance of recurrence.

We’re all quite aware of breast cancer, and most women do their best to
routinely screen themselves for problems. Cats can get breast cancer
too, and the type they get is usually malignant. Cats most at risk for
developing breast cancer are unspayed older females, cats who had lit-
ters earlier in their lives, and cats who were spayed after they had sev-
eral heat cycles.
     The risk of breast cancer in a cat who has never had a heat cycle is
close to zero, so again, this is another reason to spay a young animal.
There are no other specific actions you can take to prevent breast can-
cer, but monitoring the mammary glands for lumps so that any prob-
lem can be detected early is a good idea.
     There are astute owners who feel the lumps on their cats. Initially,
a malignant growth will feel like a hard BB near one or more of the
nipples.The smaller the growth and the earlier it is removed, the better
the cat’s chances for survival.
     During a routine annual physical exam, a veterinarian should palpate
all eight mammary glands on a cat and search for lumps. Occasionally
cats will develop cysts or benign growths, but a biopsy is the only way
to know the exact status of a lump.
     Most often a veterinarian will remove the entire growth, rather than
take a small biopsy. Mammary cancer tends to run down the mamma-
ry chain first on one side, then the other, so a radical mastectomy may
be recommended. All of the glands on one or both sides are removed
in a radical mastectomy.
     Mammary cancer is not strictly a disease of female cats; male cats
can be affected, too. Even though they have not been in heat or had
                                                The Endocrine System   189

female hormonal stimulation, male cats have nipples. If you have a male
cat with a growth near a nipple, have it examined by a veterinarian.
     As with most cancers, it’s important to begin treatment right away.
Surgical removal of the affected tissue and even unilateral or bilateral
radical mastectomy may be needed.The tissue should definitely be sent
for biopsy.
     Your veterinarian may recommend additional chemotherapy, or
you may want to consult with a veterinary oncologist. Chemotherapy
is an aggressive approach, but it is well tolerated by most cats and may
help to preserve a good quality of life.
     The conservative approach is to monitor the cat for recurrences,
and surgically remove any new lumps that develop.Taking chest X rays
every six months or so will monitor for metastasis of cancer to the
lungs. If a cat who has been previously diagnosed with breast cancer
starts to have problems coughing or breathing, there is a good chance
the cancer has spread to the lungs.

Adrenal gland disease is not common in cats, so only the basics will be
mentioned here. These glands are located near the kidneys and are
responsible for producing mineralocorticoids and glucocorticoids.
Mineralocorticoids are hormones responsible for regulating sodium and
potassium balance in the body. Glucocorticoids regulate glucose, pro-
tein and fat metabolism within the body and have effects on inflamma-
tion and immune response. Small amounts of sex hormones are also
produced in the adrenal glands.
    Cushing’s disease is the term for hyperadrenocorticism, which is
overactive adrenal hormone production. Signs of this disease are
increased thirst, urination and appetite, hair loss, muscle weakness and
thin skin. It is diagnosed with special blood tests and ultrasound.
Treatment involves suppressing hormone production or surgically
removing an adrenal tumor, if present.
    Addison’s disease is the term for hypoadrenocorticism, which is
underactive adrenal hormone production. Signs of this disease are vom-
iting, diarrhea, general malaise and poor body condition. It is diagnosed
with special blood tests. Treatment involves hormone supplementation
and supportive care for shock if the condition is advanced.
Chapter 19

The Nervous System and
the Senses

What makes a cat want to hunt birds? Why does a cat recognize the
sound of the can opener? How does a cat think? How do reflexes work?
These and many other questions are answered by the intricate feline
nervous system. It is the control panel for every sense and body system.
    The central nervous system is composed of the brain and spinal
cord. The brain is the computer that commands the other parts of the
body. Cerebral spinal fluid surrounds the brain and spinal cord and
acts as a shock absorber. It helps prevent concussions when the head is
    There are five primary senses: vision, hearing, touch, smell and taste.
There are additional body-monitoring sensors for balance, temperature,
muscle tension and blood oxygen level.
    There are millions of stimuli bombarding the nervous system every
second. The able central nervous system makes sense of it all and
preserves and protects each animal, so it is important that it functions
properly. Damage or disease affecting the nervous system can have
far-reaching implications.

                                       The Nervous System and the Senses   191

The eye can be compared to a computerized camera. The pupil is the
camera’s aperture, or opening, and can change from wide open to bare-
ly open. The iris works as the shutter, regulating the amount of light
entering the eye.The lens is the focusing mechanism.The retina is the
film; it is where photoreceptors convert the image into electrochemical
signals. Nerves to the brain are the computer lines that transmit the sig-
nal. The brain is where the finished photo is assembled. There are
193,000 optic nerve fibers that transmit information to the cat’s visual
cortex in the brain.
    Diseases such as cataracts, dry eye, eyelid deformities and glauco-
ma are not frequently found in cats. Most veterinarians can treat com-
mon diseases of the eyes, but will refer you to a specialist if needed.
Board-certified veterinary ophthalmologists have specialized equip-
ment and can perform advanced diagnostic and surgical procedures
on the eyes.

A Scratch on the Eye
A common cause of a squinting and red eye in a cat is a corneal ulcer.
Corneal ulcers are irregularities on the surface of the eye. They are
detected by placing a drop of a fluorescent dye on the eye surface and
then rinsing it off. A normal cornea is smooth, and the dye will flush
off. If any abrasion, scratch or other lesion is present that has affected
the integrity of the cornea, the dye will stick to it.
     Ulcerated corneas are quite uncomfortable to an animal, so you
may see a decreased activity level in a cat with an ulcer.
     In the springtime when plants and weeds are growing, it is common
for cats to accidentally get foxtails in their eyes. Foxtails are pointy grass
awns that are quite sharp and can get stuck under the eyelids when a
cat goes outdoors. If you live in an area where these annoying plant
seeds are present, be on the lookout for them. They can also get stuck
between toes and in ear canals, and be found throughout a cat’s coat.
They can penetrate into the skin and cause more serious problems,
as well.
     An antibiotic drop or ointment is usually prescribed to treat a
corneal ulcer. A protective Elizabethan collar may be recommended as
well.An Elizabethan collar is the protective “lampshade” animals wear to
prevent them from rubbing their eyes or faces or to stop licking an area.
192 Guide to a Healthy Cat

    Lesions can clear up in about a week if they are properly treated. If
the eye is very painful and the cat squints it shut, another drop called
atropine may be added to decrease eyelid spasms and discomfort.
    Many prescription eye drops and ointments contain a combination
of antibiotics and cortisone. Drops that contain cortisone should never
be used on cats with corneal ulcers, because cortisone retards corneal
    Persian and Himalayan cats have very prominent eyes that are easily
injured. These cats can develop a condition called corneal sequestrum,
in which part of the cornea actually dies and turns black. A veterinary
ophthalmologist can perform a procedure called a keratectomy to
remove this damaged corneal tissue.A corneal sequestrum is not painful,
but it will block vision through that part of the cornea.

Kitty Pinkeye
The most common problem directly affecting the eyes of cats is con-
junctivitis.This inflammation of the tissue around the eye can result from
viral or bacterial infection, allergies, trauma or immune-related diseases.
Conjunctivitis does not directly affect vision, but it can do so indirectly
if a cat is squinting due to discomfort or if the cornea is also affected.
     A red, puffy eye or an eye that is tearing are typical signs of con-
junctivitis. Cultures and conjunctival scrapings are not routinely reliable
diagnostic tools, so it can be difficult for a veterinarian to determine the
exact cause of a case of conjunctivitis.
     It is not uncommon for kittens to be infected with feline her-
pesvirus or chlamydia, which can cause conjunctivitis. Both can be dif-
ficult to treat, and herpes can cause recurrent draining of the eye and
conjunctivitis throughout the cat’s life. Feline chlamydia can be trans-
mitted to humans and cause conjunctivitis. To prevent the spread of
infection, wash your hands before touching your own eyes after han-
dling a cat with conjunctivitis.

Can’t Stop Crying
Many cats have eyes that tear regularly. The most common cause of
chronic tearing is a flare-up of a feline herpesvirus infection, or scarring
of the nasolacrimal drainage duct that resulted from a previous her-
pesvirus infection. The nasolacrimal duct provides drainage from the
eye out through the nose.
    Chronic tearing can also be the result of facial conformation and
breed predisposition. This is something owners of Persians and other
                                      The Nervous System and the Senses   193

breeds with shortened faces already know.The normal drainage system
for the tears does not function in these cats due to the size and shape
of the eyes and nose.They may also lack drainage ducts.
    Allergies can trigger conjunctivitis or mild chronic tearing.
Intermittent use of an eye treatment that contains cortisone can help
cats with eye problems due to allergies.
    Just as many people have “sleep” in their eyes each morning, so do
many cats.Wiping with a moist tissue or cotton ball should be enough
to clean most cats’ eyes. Short-nosed cats, such as Persians, may need
their eyes cleaned two to three times a day to prevent buildup. If the
discharge is allowed to accumulate, it can cause hair loss and dermatitis
in the skin folds around the eyes.
    Regarding ocular discharge, the general rule is that clear is good
and yellow or green is bad.A dark, crusty material in the corners of the
eyes can also be normal. Tears contain pigments that turn dark when
exposed to light.This coloration is not due to blood or infection.

Anterior Uveitis
Inflammation of the uveal tract (vascular and pigmented parts of the
eye) is called uveitis. Anterior uveitis involves the iris (the colored por-
tion of the eye surrounding the pupil) and the fluid-filled chamber in
front of it. Signs of anterior uveitis can include squinting, redness of the
eye, a cloudy appearance when looking into the eye, change of iris
color, abnormal pupil shape, tearing and a visible third eyelid.
    There are various causes of this condition, but most often a specific
cause cannot be identified. Possibilities include trauma, viral infections
(including feline herpes, FeLV, FIV and FIP), fungal infections (such as
cryptococcus), parasitic infections (such as toxoplasmosis) and even can-
cer. Blood tests are useful for identifying some of the infectious causes.
    Treatment for uveitis involves using topical and sometimes oral
anti-inflammatory drugs, along with treating any underlying disease.
Monitoring for secondary glaucoma is recommended, because inflam-
mation in the eye can lead to a buildup of fluid pressure in the eye

Should You Worry About Blindness?
It is normal for the lenses in a cat’s eyes to thicken with age and for clar-
ity of vision to diminish.Very few felines go blind from cataracts; blind-
ness is usually the result of another condition or trauma. If a cat loses
vision in one eye, an owner may not even realize it because the animal
194 Guide to a Healthy Cat

will still be able to function fairly normally. Even when both eyes are
blind, a cat can get around quite well in familiar surroundings, and will
use her other senses to compensate for her lack of sight.
    The most common cause of blindness in cats is acute retinal detach-
ment, which occurs as a result of high blood pressure. If blood pressure
is controlled and the retina does not become torn or scarred by bleed-
ing, it will reattach and vision will be restored.

The anatomy of the cat’s ear is complicated, and the way it functions is
amazing. The precise interactions involved occur in milliseconds.
Balance and equilibrium are reflexes that involve the ears. The brain
processes the information it receives from the ears and reacts without
any conscious thought.

Assessing the hearing abilities of a cat is difficult.The only definitive diag-
nostic tool is the electroencephalograph, which measures brain waves in
response to sound stimuli.This test is performed under anesthesia and is
only available through certain veterinary specialists. It is specifically called
brain stem auditory evoked response (BAER) testing. Most veterinarians
rely on less scientific testing, such as the animal’s response to a loud noise.
    Loss of hearing in cats can be the result of a variety of problems.
Trauma to the head or ear canals can impair hearing or cause complete
deafness. Aging changes can decrease hearing, but complete deafness is
not common in old cats.
    Deafness in cats can be a congenital abnormality. Developmental
problems during gestation could lead to improper formation of ear
structures. White cats, especially those with blue eyes, have a higher
incidence of deafness. This is because of genetic defects that cause
numerous abnormalities in the bones of the ear.
    Tumors in the ear or brain could affect hearing abilities. Prolonged
administration of certain antibiotics can cause hearing loss by damag-
ing the hairs in the organ of Corti. Ear infections can cause permanent
damage to the tympanic membrane (eardrum), middle or inner ear.
    At this time, hearing aids are not available for cats. If you have a deaf
cat, you need to protect her from outdoor dangers. Hearing is more
important to a cat who spends unsupervised time outside. Good hearing
                                      The Nervous System and the Senses   195

will help alert a cat to cars and other animals that can pose a threat. Deaf
cats are at risk when they are outside unsupervised.
    Deaf cats are easily startled, and in my experience can be more
aggressive.This may arise from the cat feeling more defensive due to an
inability to hear anyone approaching. Still, deaf cats can make good pets
and live normal life spans. If you are unsure about your cat’s ability to
hear, consult your veterinarian.

Head Tilt
A head tilt is a sign of diseases of the external, middle or inner ear as
well as diseases of the brain. Diseases that affect the ear include trauma,
bacterial or mite infections, polyps, tumors, foreign bodies, punctured
eardrums and ototoxic drugs. In addition to a head tilt, other possible
clinical signs of ear disease are circling, loss of equilibrium, vomiting
and listlessness. A head tilt could be a symptom of serious disease, so a
thorough workup by your veterinarian is warranted.
    The workup for a head tilt is similar to that of other neurological
diseases, and may include an exam of the ear canals and tympanums
(eardrums), blood and urine tests, skull X rays, CAT or MRI scans,
cerebral spinal fluid tap and a BAER test. Treatment and prognosis
depend on the cause, but cats with head tilts often need help in getting
around, jumping up or down, using stairs, eating and getting in and out
of the litter box.

A seizure is an uncontrolled release of electrical activity from the neu-
rons of the brain.When you observe a seizure, it may seem as though it
lasts for a long time, but in reality seizures rarely last more than 30 to
60 seconds. Seizures are scary, because your normally responsive pet will
not recognize you and may even bite you if you try to hold her down.
     There is nothing you can do to stop a seizure in progress.The best
thing to do is to be sure the animal cannot fall off something and hurt
herself, and then leave her alone.Why do cats have seizures? There are
many possible causes.
     Epilepsy, a disorder that triggers recurrent seizures but has no under-
lying disease process occurring in the brain, is not as common in cats as
it is in dogs or humans. Most feline seizures are triggered by specific
causes. Idiopathic epilepsy is a seizure condition with no known cause.
196 Guide to a Healthy Cat

Diagnosing Seizures
A diagnostic work-up for seizures and other diseases of the brain will
initially include a history, physical and neurological exam, a complete
blood count and chemistry panel and urinalysis. If the veterinarian is
unable to make a specific diagnosis based on this information, and the
cat is continuing to have seizures, further diagnostic testing should be
pursued. Such tests might include:

     •   Blood pressure measurement
     •   Skull X rays
     •   Cerebral spinal fluid tap and analysis
     •   Electroencephalogram (EEG), a kind of brain scan
     •   Computerized tomography (CT) scan
     •   Magnetic resonance imaging (MRI)
     •   Radioisotope brain scan

    As you might imagine, it can be expensive to pursue a definitive diag-
nosis, and referral to a veterinary neurologist may be needed to provide
access to diagnostic equipment and to properly interpret the test results.
    There are many possible causes for seizures, including:

     •   Congenital disease
     •   Metabolic disease
     •   Neoplasia
     •   Nutritional imbalances
     •   Infections with viruses, bacteria, protozoa or fungi
     •   Trauma
     •   Toxins
     •   Parasites
     •   Vascular disorders

Treating Seizures
If a specific trigger for the seizures is identified, treatment for the
underlying problem may be successful in controlling future seizures.
Some of these conditions are more responsive to treatment than others.
    If a seizure is an isolated incident, no treatment may be recom-
mended. If seizures occur at least once a month, oral anticonvulsant
                                       The Nervous System and the Senses       197

                             IT’S JUST GOOD,
                                CLEAN FUN

    Some cats almost appear to be having seizures when exposed to cat-
    nip. Catnip, Nepata cataria, is a member of the mint family. But really,
    they are just enjoying themselves.The active chemical in catnip
    is called nepetalactone, which is a hallucinogenic compound that
    induces a pleasure response in cats. A cat’s genetic makeup is a factor
    affecting the animal’s responsiveness to catnip. Apparently catnip is
    an acquired taste, as young kittens usually do not respond to it.

therapy is usually started. The most commonly used drug to treat
seizures is phenobarbital, but diazepam is sometimes used. Potassium
bromide, although effective for controlling seizures in dogs, has been
implicated as a cause of lung disease in cats.

Three congenital abnormalities are occasionally seen in cats. The first is
hydrocephalus, otherwise known as water on the brain. In a hydro-
cephalic animal, cerebral spinal fluid (not water) abnormally pools in cer-
tain parts of the brain.The classic appearance of a cat with hydrocephalus
is a dome-shaped skull. Siamese are the most commonly affected breed.
This condition is noticed in young kittens. Abnormal physical appear-
ance, behaviors and seizures may be seen, and there is no treatment.
     The second congenital abnormality can be found in some Manx
cats. Manx cats do not have normal tails, and some are born with mal-
formations of nerves and spinal cord segments. One condition is called
spina bifida, which is a defect in the closure of the vertebrae.This con-
dition leads to a protrusion of the spinal cord and nerves. The clinical
signs observed are loss of urinary and fecal control, otherwise known as
     Even if a Manx cat does not have spina bifida, she may have minor
spinal cord defects. Possible clinical signs associated with these defects
are difficulties with urination and/or defection, and rectal prolapse
(where the rectum protrudes from the anus). Most Manx cats “bunny
hop” when they run, a significantly different movement from that of
other cats.This change of gait is related to their short tails and possi-
ble vertebral malformations. Bunny hopping, without incontinence,
does not create any management problems for Manx owners.
198 Guide to a Healthy Cat

    The last congenital abnormality is cerebellar hypoplasia. This is
another condition seen in young kittens.The signs are tremors, imbal-
ance and an exaggerated gait.There is no treatment for this condition.
Owners need to decide if they can live with a pet who does not func-
tion normally. Cats with cerebellar hypoplasia need help eating, elimi-
nating and getting around, although their external physical appearance
is normal.

Compared with dogs, cats have quite flexible backs. Thick, spongy
cushions between their vertebrae enable cats to extend and contract
their spines like an accordion. As a result, they don’t often sustain back
injuries. If injury or disease affects a cat’s spine, clinical signs might

     •   Limb weakness or paralysis
     •   Instability
     •   Stiff or painful muscles
     •   Loss of normal reflexes
     •   Urinary or fecal incontinence

    The diagnostic work-up options for cats with suspected spinal prob-
lems are similar to those for brain disease. Additional tests that might be
performed are a myelogram (an X ray taken after dye is injected around
the spinal cord), an electromyelogram (which measures the electrical
activity of muscles) or an MRI (magnetic resonance imaging). Some dis-
eases of muscles have clinical signs similar to those caused by nerves.

Traumatic Experiences
Examples of trauma that can damage the spine are when a cat is hit by
a car or becomes stuck under a garage door.The back end of the ani-
mal is most often affected in these situations.The tail can be damaged,
back end nerves can be torn and the spinal cord can be injured. Cats
are amazing creatures with an unbelievable capacity to heal. Many cats
with severe damage will regain normal function with treatment, tender
loving care and time.
    Generally with spinal disease, the more severe the signs, the less
optimistic the prognosis. Once a nerve is cut, it will not reconnect, but
                                     The Nervous System and the Senses   199

it can regenerate at a very slow rate. It is not particularly difficult to
control pain and inflammation in cats who have sustained trauma, but
managing the inability to eliminate is difficult. If control of these
processes has not returned within a couple of weeks, it most likely will
not return. Owners can be faced with making a decision about
euthanasia if the animal is unable to regulate her bodily functions.
    Cats with broken, limp tails can do very well, if there are no other
problems, by amputating their tails. When the tail loses feeling and
motor control, it is not doing the cat any good anyway, so it is best to
surgically remove it.

Kitties With Slipped Disks
Intervertebral disk disease is occasionally seen in cats. A veterinarian
might suspect a disk problem in a cat as he pinches down the spine from
the neck to the tail and finds a sensitive spot, and the cat presents with
pain, instability, weakness or paralysis. Disks in the neck are more com-
monly affected than those farther down the spine. Disks can degener-
ate with aging, be pushed out of place by trauma or tumors, become
infected or be pinched by arthritic changes.
    If intervertebral disk disease is diagnosed, the cat should be confined
so that she can rest, and anti-inflammatory doses of cortisone used to
help with pain and swelling. If the condition progresses to paralysis, sur-
gical decompression of the spinal cord is needed immediately.

Cauda Equina Syndrome
This condition has clinical signs that are very similar to intervertebral
disk disease, although it affects only the nerves at the end of the spinal
cord. Cauda equina syndrome occurs most frequently in senior cats.
Signs observed in cats with cauda equina syndrome include:

     •   Difficulty in rising
     •   Rear-limb lameness that progresses with use
     •   Dragging the rear toes
     •   Rear-limb and tail weakness
     •   Urinary or fecal incontinence
     •   Pain at the lumbosacral junction of the spine, the area of the
         spine where the lumbar and sacral veterbrae come together in
         the lower back
200 Guide to a Healthy Cat

    If treatment with rest and corticosteroids does not give the cat sig-
nificant pain relief or return of function, discuss decompression surgery
with your veterinarian.
    If your cat requires surgery on any part of her spinal cord, consider
consulting with a board-certified veterinary surgeon. Spinal surgery is
a delicate and risky procedure that is best left to the experts.

Staring off into space and chasing objects we can’t see are normal feline
behaviors, but these behaviors can become more extreme in cases of
hyperesthesia. No one knows what actually causes this syndrome, but it
is typically seen in young adult cats.
     The most common sign of hyperesthesia is frantic licking and bit-
ing at the air, especially when the cat is touched around the end of her
spine. Other possible signs are mood swings, vocalizations, seizures,
excessive grooming, skin rippling, dilated pupils, tail swishing and
hyperactive behavior.
     I have seen mild forms of this condition most often in overweight
cats with matted coats and fleas.They cannot reach around and scratch
themselves, so they go crazy when scratched or combed along the end
of their spines. I think the stimulation is so overwhelming because the
cat has been dying to do the same herself but cannot. Regular groom-
ing, flea control and use of anti-inflammatory drugs often control the
     There are more extreme manifestations of hyperesthesia with pro-
longed unpredictable behavior. There are many theories about what
triggers this bizarre behavior, including an underlying seizure disorder,
obsessive-compulsive behavior, an inherited reaction to stress, and mus-
cle inflammation and abnormalities.
     If the problem does not respond to skin care, treatment should focus
on relieving stress, engaging the cat in play activities and medicating
with either anti-anxiety drugs or the anticonvulsant Phenobarbital.
Chapter 20

The Urinary Tract

The popularity of cats has flourished over the last decade because of
their ability to thrive with less human care than a dog requires. Their
willingness to use a litter box is a big part of this, since owners do not
need to rush home to take their cats out for a walk. Cats are born with
the instinct to bury their urine in dirt or sand, and proper litter box use
makes things comfortable for both cat and owner.
     When a cat stops using his litter box, the very first thing to suspect
is a medical problem. Previous chapters have mentioned diseases, such
as diabetes, where frequent or inappropriate urination is one of the
signs. There are also health problems that can affect the urinary tract
     The urinary tract is composed of the kidneys, which are responsi-
ble for filtering blood and producing urine; the ureters, which transport
urine from the kidneys to the bladder; the bladder, which stores urine;
and the urethra, which is the passageway from the bladder to the penis
or vulva. All parts of the urinary tract play a role in eliminating fluid
waste products from the body.

202 Guide to a Healthy Cat

Lower Urinary Tract Disease (LUTD) is a broad term encompassing
many different syndromes. The lower urinary tract of cats involves the
bladder and urethra.
    Theories about what causes bladder problems in cats have changed
over the past 20 years. In the past, owners were concerned about the
“ash” content (and later the magnesium content) of their cat’s food, but
LUTD involves a complex interaction between genetics, diet, water
intake and stress.
    Recommendations about canned food or dry for cats with bladder
problems have gone back and forth, and recently the pendulum has
swung back to recommending more canned food. Canned food
increases a cat’s water intake. If cats will not eat canned food, moisten-
ing dry food or installing a circulating water drinking fountain are two
other ways to increase water intake.When a cat drinks more water, his
urine is more dilute and crystals, which are among the main culprits in
LUTD, are less likely to form in the urinary tract.
    The feline urinary tract is a part of the cat that is constantly being
researched in academia and the pet food industry, so expect new infor-
mation to be available each year. Litter box use and diet are important
issues to discuss with your veterinarian at each annual visit, since they
both have an impact on the urinary tract.

Blood in the Urine
Bloody urine is a frequent finding in cats with LUTD. Owners notice
blood in the litter box or on other objects the cat has decided to elim-
inate on. Blood is a sign of inflammation of the bladder (cystitis), but it
does not necessarily mean a bacterial infection is present.

                         DIFFERENT NAMES,
                          SAME PROBLEM

    You may hear your veterinarian use the acronym FUS when refer-
    ring to urinary tract problems. FUS stands for Feline Urologic
    Syndrome. Medical personnel may use the terms LUTD and FUS
    interchangeably, but the former is the more accurate terminology
    used today.
                                                      The Urinary Tract 203

     A veterinarian must examine cats with blood in their urine. The
veterinarian will want to perform a urinalysis to help reach a diagno-
sis. A proper urinalysis will:

     •   Check the cat’s ability to concentrate urine
     •   Show if red and/or white blood cells are present
     •   Show the pH of the urine
     •   Show if glucose is present
     •   Evaluate protein levels in the urine
     •   Check for the presence of other metabolic chemicals, crystals,
         or cells

   Urine can be cultured for bacteria, and antibiotic sensitivities can
then be determined. For advice on how to collect a urine sample, see
Chapter 22.
   There are a host of reasons for blood in a cat’s urine, including:

     •   Bacterial infections
     •   Viral infections
     •   Trauma to the kidneys or bladder
     •   Stress
     •   Bladder stones
     •   Crystal buildup
     •   Tumors
     •   Blood clotting disorders
     •   Idiopathic (no known cause) interstitial cystitis

     Interstitial cystitis is a benign inflammatory condition that can affect
the bladders of cats. It is one of the LUTD syndromes. Although there
are no treatments that have been conclusively proven effective for every
cat, veterinarians can prescribe a mild human anti-anxiety drug called
amitriptyline. It is often effective in cases of human interstitial cystitis.

How to Make Your Cat More Comfortable
Cats with LUTD may strain to urinate and pass only a few drops
of urine at a time.You will observe them making frequent trips to the
204 Guide to a Healthy Cat

                         SENDING A MESSAGE

    Cats who urinate outside of their litter box may be trying to get
    your attention and let you know they are not well. Don’t automati-
    cally blame the problem on bad behavior. Have the cat examined
    by a veterinarian so that if there is an underlying medical problem,
    such as LUTD, it can be treated.

litter box.The most important factor is that they are able to pass some
urine, differentiating them from cats with urinary blockages.
     The results of a physical exam and urinalysis will give a veterinari-
an a good idea about what is causing LUTD. Controlling bacterial
infections is fairly easy with antibiotics, but decreasing the straining and
increased frequency of urination can be more difficult. A host of med-
ications can be tried, and time can also heal. It usually takes three to five
days for a case of LUTD to improve.
     When cats have recurrent bouts of LUTD, further diagnostic test-
ing is needed.Tests that are helpful include:

     • X rays
     • Contrast X rays (where the bladder is first injected with a
       contrasting dye—this enables better evaluation of the lining
       and certain stone types)
     • Ultrasound
     • Urine culture
     • Bladder biopsy

If an owner calls my clinic and tells my receptionist that his cat can’t
urinate, she becomes alarmed, especially if a male cat is involved. Due
to the length and shape of their urethra, male cats are more susceptible
to developing life-threatening urethral obstructions. This narrow exit
passageway from the bladder can become clogged with mucus, crystals
and even small stones.
                                                      The Urinary Tract 205

    A cat who cannot urinate should be examined immediately, because
if he is truly obstructed, he could die within hours from to toxins build-
ing up in the blood and pressure on the kidneys.

It’s Going to Cost How Much?
It is good to know ahead of time that effectively treating a urinary
blockage is expensive. Expenses will be even higher if you must visit an
emergency veterinary clinic, but you really have no choice. Factors that
affect the amount of treatment a cat will need are:

     •   Duration of the obstruction
     •   Whether there is kidney damage
     •   The degree of difficulty in unblocking the urethra
     •   The cause of the obstruction
     •   Whether the cat blocks up again

     Each veterinarian will probably treat a blocked cat a little different-
ly, but the basic steps are:

    1.   Pass a urinary catheter into the bladder.
    2.   Drain out the retained urine.
    3.   Determine what other metabolic imbalances exist.
    4.   Treat for infection and shock (if necessary).
    5.   Maintain the cat’s hydration.
    6.   Flush debris out of the bladder.
    7.   Evaluate the cat’s ability to urinate once the catheter has been

    A blocked cat may require one to five days of hospitalization and
nursing care. Home care will likely involve treatment with antibiotics
and possibly a diet change. Some cats need medication to relax their
bladders and urethras to ease elimination.

Three Strikes and You’re Out
For some reason, some cats that will become re-obstructed. Medication
and diet are just not enough to keep things flowing smoothly. Again,
206 Guide to a Healthy Cat

each veterinarian will have their own approach to the problem, but my
rule is that if a cat obstructs three times, he needs a procedure called a
perineal urethrotomy.
    We call perineal urethrotomy surgery our “kitty sex-change opera-
tion” because afterward, the urinary tract and genitalia look more like
those of a female than a male. Males are more prone to obstruct because
of their narrow, twisting urethra that ends at their penis. Females have a
short, wide urethra that ends in the vulva. Cats who have perineal ure-
throtomies lose their penis, and are given a new opening from which
to urinate.
    This surgery successfully opens up the urethra, but it is not without
risk. If it is not performed carefully, or if there is trauma or excessive
scarring, a cat may not be able to control his urination and dribbling
will occur. Scarring can also cause another obstruction.The shortened
urethra may increase the likelihood of bacteria entering the urinary

Stones can form throughout the urinary tract, but are most often seen
in the bladder. The medical term for stones of the urinary tract is
uroliths. Kidney stones are the second-most frequent type of urolith, but
unless they block the ureter, they are usually left alone.
     When dissolved minerals are present in high concentrations in the
urine, they can reach a saturation point and begin to precipitate out of
the urine as crystals. Bladder stones are formed this way—which is sim-
ilar to the way rock candy is formed. Some crystals stick together to
form a small center, then other crystals join on and make a stone.
     Struvite is the name used to describe magnesium ammonium phos-
phate crystals or stones. High levels of magnesium, combined with a
high urine pH, create an environment that enables struvite to precipi-
tate in the urine.
     Calcium oxalate, ammonium and urate stones can also develop in
cats when certain metabolic conditions exist. Each type of stone
requires different conditions to form. Some can be controlled by diet,
but others can be difficult to prevent.
     Struvite stones are the only type that can be dissolved by feeding a
special prescription diet, which is only available through veterinarians.
After a stone-dissolving diet is fed for about two months, a preventive
diet is fed to prevent recurrence. To monitor the response to diet, fol-
low up X rays of the bladder are needed.
                                                                    The Urinary Tract 207

How Stones Are Diagnosed
It is not common to feel stones in a cat’s bladder on palpation, because
the stones are relatively small. Stones should be suspected any time a cat
has more than one episode of LUTD or develops a urinary blockage.
Most feline uroliths are visible on regular X rays, if they are large
     To make stones more visible, a special X ray called a pneumocys-
togram is performed. The procedure involves putting a catheter in the
bladder and injecting air as a contrast agent. Ultrasound is also able to
detect small stones and piles of crystalline sand on the bladder floor.
     Urine pH, appearance on X ray and blood work can give clues as
to the type of stone present. A definitive identification of the stone is
performed at a lab, where its chemical components are analyzed.

Treating Stones
If the veterinarian is unsure whether the stones will dissolve with a
change in diet, or if you want to get them out and make your cat



Two large bladder stones and a very thickened bladder wall are revealed in this special X ray,
called a pneumocystogram.
208 Guide to a Healthy Cat

                                             comfortable as soon as possible,
                                             surgical removal is recommended.
                                             The procedure is called a cystoto-
                                             my and involves abdominal surgery
                                             and an incision into the bladder.
                                             Stones are removed, and the blad-
                                             der and urethra are flushed out.
This bladder stone has been surgically
                                                 The bladder is an organ that
removed. It is almost one centimeter across.
                                             heals incredibly well, so although it
                                             seems traumatic at the time, cats
have excellent recoveries from cystotomies.The key to success with the
surgery is thorough removal of all stones and follow-up with an X ray.
    In certain situations, urohydropropulsion can be used to remove
stones. Urohydropropulsion is a technique that forces small uroliths out
of the body, and is an option for female cats with small stones.
    If your cat is found to have stones that cannot be prevented with
diet, there is a good chance they will recur.There are usually some steps
that can be taken to decrease risk, but the cat should be monitored with
urinalyses and X rays about every six months.

It is normal for cats to have some crystals in their urine.To determine
whether crystals are a problem or not, the number of crystals, the pres-
ence of other cells and the pH of the urine should all be taken into
consideration. Your veterinarian may recommend a special diet if she
feels crystals in the urine are a problem.
     Most cat foods are now low in magnesium and are formulated to
mildly acidify the urine (remember, higher acid is the same as lower pH).
This is because research has shown these dietary changes can help
reduce the likelihood that a cat will form struvite crystals. A carnivore
like the cat would naturally have slightly acidic urine, so this makes
     The incidence of struvite formation in cats has declined since cat
food makers began reformulating their food. However, only about 15
to 25 percent of all cases of LUTD are caused by struvite stones. And a
mildly acidifying diet has increased in incidence of cats with calcium
oxalate stones, which form more easily in acid urine.
     There are prescription brands and grocery store cat foods that are for-
mulated to improve urinary tract health.The grocery store brands usually
                                                     The Urinary Tract 209

are made to help with struvite formation, while your cat will need a pre-
scription brand food that helps with calcium oxalate stones. If your cat
has a history of urinary tract problems, the urine should be monitored
after his diet is changed to be sure the correct balance is being achieved.
    I would not recommend feeding a special urinary tract diet with-
out first consulting your veterinarian. Special diets may be harmful to
young, growing kittens or older cats with other medical conditions.
    As I’ve mentioned, feeding more canned food and increasing water
intake is recommended for cats with urinary tract problems. Special
diets are usually available in canned and dry forms. Ultimately, your cat
may be the decision-maker and choose what he is willing to eat.

The kidneys are responsible for filtering out waste products from the
blood, conserving water in the body and producing urine. A cat’s body
is a wonderful machine, and even though it works best with two kid-
neys, it can do well with one kidney or 50 percent kidney function.
     Your veterinarian (or your physician) might use the term renal to
describe things having to do with the kidneys. For example, renal insuf-
ficiency means loss of kidney function.
     There are many diseases that can affect the kidneys, but regardless
of the cause, most renal diseases are treated similarly.The prognosis for
cats with kidney disease depends on whether the disease is acute or
chronic. Long-standing problems tend to have a less favorable outcome.
Unlike other vital organs, such as the liver, the kidneys are not capable
of regenerating themselves.

Signs of Dysfunctional Kidneys
Clinical signs associated with kidney disease are similar to those of other
diseases, and can include:

     •   Increased thirst
     •   Increased urination
     •   Weight loss
     •   Dehydration
     •   Dental disease
     •   Vomiting
210 Guide to a Healthy Cat

         DEADLY ANTIFREEZE                          Blood tests and urinal-
                                               ysis results will not indicate
     Antifreeze is a potent toxin when         that kidney function is
     ingested by cats. A chemical in           compromised until more
     antifreeze, ethylene glycol, irre-        than 50 percent function is
     versibly destroys kidney cells. If        lost. In fact, they may not
     you have any reason to suspect
                                               show abnormal results
     your cat has licked even the tiniest
     bit of antifreeze, get him to a           until more than two-thirds
     veterinarian immediately. If treat-       of kidney function has
     ment is not started within four           been affected.
     hours of ingestion, the prognosis              The most common
     is very poor.                             parameters for assessing
                                               kidney function are blood
                                               levels of BUN and creati-
                                               nine, and urine-specific
gravity. BUN stands for blood urea nitrogen, a breakdown product of
protein metabolism. Creatinine is another type of nitrogenous waste
product. Both build up to abnormal levels when the kidneys aren’t work-
ing. Urine-specific gravity relates to the concentrating ability of the kid-
neys. Cats typically have very concentrated urine, meaning it has low
water content. In cats with kidney disease, the urine-specific gravity drops
because the urine becomes dilute and too much water leaves the body.
     Cats with kidney disease tend to become dehydrated. A skin turgor
test is a simple procedure that cat owners can do at home to check on
their cat’s hydration. If neck skin is pinched up and does not fall back
into place within a second or two, the cat is significantly dehydrated. In
this situation, injectable fluid supplementation is probably needed.

Kidney Infection
Pyelonephritis and glomerulonephritis are terms used to describe
infection and inflammation involving different cells within the kidneys.
Because the kidneys filter all of the body’s blood, any infectious agent
in the blood is transported to the kidneys.
    The clinical signs of pyelonephritis are the same as other types of
kidney disease, but fever and pain on palpation of the kidneys may be
present.White blood cells can also be present in the urine.
    Young adult cats are most often affected with glomerulonephritis,
although it is not a common disease. It can present itself in two ways:
nephrotic syndrome and renal failure. In nephrotic syndrome cats develop
                                                     The Urinary Tract 211

swelling, fluid in their abdominal cavity, high levels of protein in their
urine, increased blood cholesterol levels, decreased blood albumin levels,
mild weight loss and loss of appetite.
    Kidney infections are very serious, and are usually treated by giving
intravenous antibiotics. After initial treatment, oral antibiotics can be
used, but three to six weeks of medication may be needed. When
pyelonephritis is suspected, a urine culture and antibiotic sensitivity
should be started before treatment begins, and done again afterward as
follow-ups to treatment.

Breed-Specific Kidney Disease
Particular kidney diseases are seen in certain lines of purebred cats.The
two most common types are renal amyloidosis in Abyssinians and
Somalis, and polycystic kidney disease in Persians and Himalayans.
Genetic kidney diseases cannot be cured and are progressive.Treatment
focuses on keeping the cat comfortable and maintaining fluid and elec-
trolyte balance.
    There is no screening test for renal amyloidosis, but it is suspected
in young to middle-aged purebred cats who develop kidney disease of
no other known cause. A kidney biopsy can be performed that may
show the particular protein deposits that are the characteristic lesions of
this disease.
    Polycystic kidney disease (PKD) is found in purebred cats and in
related longhaired cats.This disease can be diagnosed by feeling lumpy,
bumpy kidneys on palpation and by seeing the cysts on ultrasound.The
presence of cysts will not necessarily cause significant kidney disease,
and some affected animals live normal lives. Others develop kidney
dysfunction at a young age as the cysts grow and destroy the normal
kidney tissue.

Old Cat Kidneys
The kidneys tend to wear out faster in cats than other organs. Chronic
tubulointerstitial nephritis is the medical term for the slowly progres-
sive loss of kidney function found in older cats. It is the most common
disease of cats over the age of 10 years.
     As a cat ages, the kidneys scar and become smaller and less efficient
at filtering the blood and preserving water balance in the body. The
progression of chronic tubulointerstitial nephritis can vary depending
212 Guide to a Healthy Cat

on the individual animal and the amount of nursing care an owner is
willing to do.The goals of treatment are:

     •   Maintain hydration and electrolyte balance
     •   Keep blood waste product levels down
     •   Prevent anemia
     •   Control secondary infections

    Although veterinary diets with lower protein levels have been
developed for cats with kidney disease, the amount of protein in these
diets is controversial. Cats are carnivores, so when their physical condi-
tion is diminished, adequate protein is needed more than ever. On the
other hand, the breakdown products of protein metabolism become a
problem in cats with kidney disease.The dietary needs of cats with kid-
ney disease are significantly different from those with bladder disease, so
pick a diet with the help of your veterinarian.

Specific Treatments
Fluid therapy is the cornerstone of helping cats with kidney disease.
The fluids given to affected cats are balanced electrolyte solutions. Cats
who have high levels of waste products in their blood should initially
be treated with intravenous fluids (diuresis). They also may be given
diuretics to help flush waste products.
    Diuresis is easily performed in most veterinary hospitals over sever-
al days of treatment. (This differs from hemodialysis, a common human
treatment. In hemodialysis, a machine removes the blood from the body
and cleans it when the kidneys are unable to do the job. This kind of
dialysis for animals is only available at a few specialty referral hospitals
and is most useful in cases of acute renal failure, where the kidneys are
likely to heal if given time.)
    In cases of chronic kidney disease, owners can learn how to inject
fluids under the skin of their pets.This procedure, called subcutaneous
administration, can be done at home long term. In my clinic, we have
owners who have happily given their cats subcutaneous fluid injections
for years.
    Maintaining proper levels of minerals in the blood is important in
controlling kidney disease. The two minerals that need to be closely
                                                      The Urinary Tract 213

watched are potassium and phosphorus. Cats with kidney dysfunction
tend to have insufficient levels of potassium but an overabundance of
phosphorus. Potassium supplements and phosphate binding agents can
be used to create the right balance. Some veterinarians treat cats with
kidney disease with a drug called calcitriol, to control phosphate and
calcium levels.
    Cats suffering from chronic kidney disease can become anemic
because their kidneys stop producing enough erythropoietin, a hor-
mone that stimulates the bone marrow to produce red blood cells.
Erythropoietin can be supplemented by injection if the red blood cell
count gets too low, and this is another treatment owners can learn to
    Some cats with kidney disease become anorexic and can be helped
with appetite stimulants, anabolic steroids and by hand-feeding. If there is
concern of nausea or upset stomach, oral antacids can be used.Antibiotic
treatment may be required if infection is a secondary problem.
    Kidney transplants are available for cats.The surgery is performed at
a few specialty clinics and universities around the country. It is an
expensive procedure with risks of organ rejection, but a successful
transplant may buy a cat a few more years of life.

Is the Clock Ticking?
Even if a cat is being well maintained on fluid therapy and other treat-
ments, kidney disease will invariably progress past a treatable stage. Cats
with kidney disease should be monitored at least every six months.
     Cats in end-stage renal disease continue to lose weight, are unable
to maintain hydration even with fluid supplementation and even devel-
op sores in their mouths. It is difficult to know how painful this is to a
cat, but there is no doubt that they are nauseous, weak and very uncom-
fortable. Euthanasia needs to be considered at this point.
Chapter 21

The Dreaded Viruses

Viruses are microorganisms that are composed of protein chains (DNA
or RNA). They are considered living organisms, although they cannot
reproduce unless they attach themselves to other living cells.They cause
infection but they do not respond to antibiotics, because antibiotics
only fight bacterial infections. Most viruses are species-specific, which
means cat viruses affect cats and human viruses affect humans.
    Viruses mutate and change, which is why people are subject to so
many flu “bugs.” There are numerous viruses that affect cats, but some
are more dangerous than others.Viruses are destroyed in the body by
the host animal’s immune system, but some viruses hide out and can-
not be totally removed. Some viruses can be fought through vaccina-
tion, which stimulates an animal’s immune system to fight the infection.

Feline Leukemia Virus (FeLV) is a serious virus in cats because at this
time it has no cure. Unlike some of the other deadly viruses that affect
cats, there are reliable screening tests for FeLV.This makes it possible to
identify sick cats and healthy cats who are carrying the virus.

                                                  The Dreaded Viruses   215

     FeLV is contagious and is passed by direct, cat-to-cat contact, such
as fighting and biting, mutual grooming and from a queen to her kit-
tens. Not all cats who contract FeLV die from the disease, but any cat
who tests positive should be monitored closely.

How Reliable Is the FeLV Test?
Most veterinary clinics have the capacity to test for Feline Leukemia in
the office, with results in 5 to 10 minutes. The most reliable tests use
small amounts of blood, but saliva and tears can be used in some test
kits. Most of the tests used in clinics are very reliable. However, when a
test comes up positive, it should be verified, because there are some-
times false positive results for the FeLV test.
     The regular test used in most clinics checks for FeLV antigens in
the blood (or body secretions). If this type of test is positive, a second-
ary, verifying test should be performed. The secondary test, called an
IFA (immunofluorescent antibody), checks for FeLV antigens within
blood cells, and is available through a reference laboratory. There also
is a test for FeLV that looks for viral DNA in the blood (FeLV PCR).
The results of different FeLV tests can be confusing if they are not all
positive or all negative. If this happens, a veterinarian should follow the
American Association of Feline Practitioner’s FeLV testing guidelines
and consider retesting before making a final diagnosis.
     Another problem with testing for FeLV is that if an animal was
exposed to the virus within a few weeks of being tested, the test could
be negative because measurable viral antigens would not yet be present
in the blood. If there is any question as to the status of a cat, he should
be retested one to three months later.

What Is FeLV?
Feline leukemia virus can suppress a cat’s immune system so that other
diseases make the animal extremely sick. It can also cause lymphatic
cancer and suppress a cat’s bone marrow and blood cell production.
Once a cat has developed clinical signs and tests positively for FeLV, the
animal usually only lives a few months, at best.
    A small number of cats contract FeLV, never get sick and live nor-
mal life spans.This is because their immune systems are able to fight off
active infection. Some animals carry FeLV and are healthy for years
before any signs of illness develop.
216 Guide to a Healthy Cat

Protection Against the Virus
There are steps that can be taken to prevent your cat from contracting
FeLV.These include:

     • Test all cats for FeLV before introducing them into your
     • Keep your cats indoors.
     • If your cats go outdoors, vaccinate them against FeLV.
     • Spay and neuter your cats so that they are less likely to fight
       and come in contact with cats who carry FeLV.
     • Lock any pet doors to prevent unknown cats from entering
       your home.

    Kittens are most at risk for infection with FeLV because of their
immature immune systems. Even if you don’t plan on letting your kit-
ten go outside, it is a good idea to test him and initially vaccinate him
against FeLV: If your kitten’s lifestyle changes and he starts going out-
doors, you would want him protected. If, after a year, the cat never goes
outside, vaccination for FeLV can be discontinued.

Coping With FeLV
If all tests and clinical signs point to a diagnosis of FeLV and the animal
is sick, the prognosis is poor. At this time there are no effective treat-
ments or cures for FeLV. There has been experimentation with some
drugs that stimulate the immune system, and although none has been
conclusively shown to have any effect, they are worth a try.
     Treatment of FeLV-positive cats is aimed at making the cat as com-
fortable as possible and controlling secondary problems. If clinical signs
respond to treatment, FeLV cats can live for years. If clinical signs are
not well controlled, an owner is usually faced with deciding whether to
continue to support the cat as his condition declines, or to humanely
euthanize him.
     Humans cannot transmit FeLV from one cat to another. FeLV does
not live outside of infected cats, but it is always a good idea to wash
your hands and clean thoroughly if an infected cat has been around.

Feline immunodeficiency virus (FIV) is in the same family as human
immunodeficiency virus (HIV), but it is not transmissible to humans.
                                                    The Dreaded Viruses   217

Although drug cocktails are currently helping humans with HIV from
developing full-blown AIDS (acquired immunodeficiency syndrome),
we have not yet made the same strides in veterinary medicine. The
good news is that FIV in cats usually does not progress to a debilitat-
ing, life-threatening condition.

How Cats Get Infected
FIV is another virus that is passed by direct cat-to-cat contact. It is most
commonly transmitted during cat fights when cats bite one another.
Not surprisingly, the highest incidence of FIV is found in stray, intact
male cats. It is rare for kittens to be infected with FIV, but it has been
documented. Most veterinarians are not worried about FIV in kittens
under the age of six months.

Diagnosing FIV
Good tests are available for detecting FIV in cats. Tests done in a vet-
erinary clinic can be completed in about 10 minutes, and the incidence
of false positives is lower than that for FeLV. If a cat fits the demographic
profile—outdoor and male—then a positive test is most likely truly
positive. One of the most popular in-clinic tests checks for FeLV and
FIV at the same time.To confirm a positive test, a test called a western
blot can be sent out to a lab.
    Whereas FeLV makes cats very sick, FIV is comparatively subtle.
This is because cats have a relatively short life span, and it usually takes
many years for the virus to create life-threatening immune suppression.
Cats are diagnosed with FIV when they are tested as new additions to
a home or if a general blood panel is run that includes viral tests. FIV
is not typically suspected as a primary disease.

The Impact of FIV
FIV does not cause cancer the way FeLV can, but it does suppress a cat’s
immune system. It usually is not a fatal disease, and there are few exter-
nal clinical signs. I have often been surprised when doing full blood
panels on cats as old as 18 years and to find a positive FIV test.
    Cats infected with FIV will have a harder time fighting other infec-
tions.They need more supportive care and a longer course of antibiotics
when they have bacterial infections.They can handle anesthesia if needed,
and they can tolerate other routine health care. It is important to extend
treatments beyond normal durations when dealing with FIV-positive cats.
218 Guide to a Healthy Cat

    One clinical sign commonly seen with FIV-positive cats is gum dis-
ease.They can have red, inflamed, malodorous gums that do not respond
to brushing. If your cat has bad gums, his FIV status should be checked
because it will affect how well the cat will respond to treatment.

Care for FIV-Positive Cats
A vaccine for FIV became available in late 2002. Unfortunately, this
vaccine is far from ideal and should only be administered if your vet-
erinarian recommends it.The first problem with the vaccine is its effec-
tiveness. In trials it protected against only two of the four common
strains of FIV, and did not confer 100 percent protection against those
two. The biggest problem is that vaccinated cats will test positive on
standard FIV screening tests, making it impossible to differentiate
between cats who have been vaccinated and cats who are infected.
     If you choose to vaccinate against FIV, I recommend first testing the cat
to ensure his negative pre-vaccine status. Be sure the cat has a microchip if
he is then vaccinated, so that if he is picked up as a stray, he will not be
destroyed because he tests positive and fits the “at-risk” description.
     There is a controversy in veterinary medicine over what should be
done with stray cats who test positively for FIV.These animals can live
relatively normal lives, but they are a potential source of viral spread. It
is not recommended to bring an FIV-positive cat into a household with
FIV-negative cats, but the animal could be a great pet in a single-cat
home or in a home with other FIV-positive cats. If no one wants the
cat and he will be returned to an outdoor life, euthanasia may be con-
sidered to prevent the spread of the disease.
     The most important thing an owner of an FIV-positive cat can do
is to keep the cat indoors. Indoor living fulfills two purposes: it decreas-
es the cat’s exposure to infectious agents, and it prevents the cat from
spreading the disease to other cats.

Feline infectious peritonitis (FIP) is one of the most frustrating and
scary diseases in veterinary medicine. It is frustrating because of the
difficulty in making a definitive diagnosis, and it is scary because there
is no cure. I hate to mention FIP to owners of a sick cat.

What Is FIP?
FIP is a coronavirus, and feline coronaviruses are common and usually
don’t cause many problems in affected cats. The current theory is that
                                                   The Dreaded Viruses   219

FIP is a mutation of a common virus called feline enteric corona virus
(FECV).Why this virus mutates to become deadly FIP in some cats is
not known. It is possible that stress, genetics, a poor immune system and
concurrent diseases may predispose a cat to developing FIP.
    The clinical signs associated with FIP can include:

     •   Fever
     •   Failure to gain weight or weight loss
     •   Lethargy
     •   Poor appetite
     •   Vomiting
     •   Diarrhea
     •   Fluid buildup in the abdominal or chest cavities
     •   Neurological disorders

    There are two forms of FIP: wet and dry.The wet form is the “clas-
sic” disease, in which fluid builds up in a cat’s abdominal and/or chest
cavity, making the animal uncomfortable and giving him a potbellied
appearance. In the dry form, the virus is present but does not create fluid.
    Cats with FIP have a waxing-to-waning illness. This means they
have good days and bad days, so an owner may not be able to tell how
sick the cat really is.The progression of signs is slow, and cats with FIP
can have undiagnosed illness for months.
    A kitten can be exposed to FECV by his mother, start off fairly
normally, and then develop full-blown FIP as late as two years of age.
Fortunately, the viral mutation to FIP usually occurs in only a small
percentage of cats, and in a litter of four kittens, one could become
infected and die and the others could grow up normal and healthy.

Building a Diagnosis of FIP
Diagnosing FIP is like putting together a puzzle.The only test that con-
clusively diagnoses the disease is a tissue biopsy. Performing explorato-
ry surgery to obtain a biopsy is not what most owners with a gravely
sick cat and a poor prognosis want to do.
    Instead, the diagnosis is presumed, based on other tests and typical
clinical signs.The tests that can be performed are:

     • Complete blood count (CBC)
     • Blood chemistries
220 Guide to a Healthy Cat

     • Corona virus titer (FECV titer)
     • 7B ELISA for FIP (an antibody titer to a specific viral protein
       (7B); a positive result supports a diagnosis of FIP, but the test is
       not definitive)
     • X rays
     • Ultrasound
     • Fluid analysis
     • FIP PCR (this test uses polymerase chain reaction technology
       to look for specific viral proteins; the test can be run on
       blood, but it is most useful on body fluids)

    A lack of response to supportive therapy and not being able to pin-
point any other disease, along with suspicious test results, can lead to a
presumption of FIP. In a multicat household it is not necessary to iso-
late an FIP suspect because all of the cats will have had same exposure
to coronavirus, and odds are that no one else will get sick.

Dealing With FIP
Owners of cats suspected of having FIP are faced with the tragic deci-
sion of ending their cat’s life as body condition and quality of life
diminishes.Veterinarians can help support the sick animals with fluids,
antibiotics, anti-inflammatories and immunostimulants, but the ultimate
outcome will be the same.Veterinarians are researching ways to effec-
tively treat FIP, so there is hope for the future.

What About the FIP Vaccine?
A vaccine is available that claims to protect cats against FIP, but the vet-
erinary community questions its effectiveness. Independent clinical
studies on this vaccine have not proven that it confers significant pro-
tection under normal conditions.

                               TITER TESTS

    Although it may be called an FIP titer, the commonly run corona
    virus titer present on many blood panels is not diagnostic for FIP.
    Cats truly infected with FIP can have positive or negative tests, and
    normal cats who have been exposed to FECV can actually have
    positive tests. An FIP titer alone means nothing.
                                                   The Dreaded Viruses   221

    The vaccine is considered to be safe and is likely most useful for cats
who have not had any previous exposure to FECV. Figuring out who
those cats are is the problem.

Decreasing Risk
FIP occurs most frequently in purebred cats who come from catteries, and
in cats who have come from shelters.This is because exposure to FECV
is higher in environments with many cats, and larger multicat facilities
have more environmental stresses and less ability to isolate sick cats.
    Purebred cats may also be more at risk due to genetics and weaker
immune systems. The more closely related cats are, the fewer different
genes there are to make their systems stronger.
    If a purebred cat breeder tells you he has never had a case of FIP in
his cattery, don’t believe him. Odds are that if a breeder has been in
business for a few years and has bred multiple litters, FIP has occurred
at one time or another.
    To try to decrease the risk of FIP, take these steps:

    1. If you go to a cattery or shelter, pick a big, healthy-looking
         kitten and have him examined by a veterinarian.
    2.   Isolate the new kitten from other cats for at least a week to
         monitor his health.
    3.   Allow the kitten to adjust to his new environment before
         performing any elective medical procedures.
    4.   Decrease environmental stresses on the animal.
    5.   Keep litter boxes and food bowls clean.
    6.   Feed the kitten a good-quality diet and be sure he is eating.

    Even if you follow these suggestions, there is no guarantee you will
prevent FIP. FIP occurs in only a small percentage of the cat popula-
tion, but it is devastating if it affects your cat.

Filling the Loss
If you have had the sad and tragic experience of losing a cat to FIP, you
may wonder when and if you should get a new cat.There is no defini-
tive answer to this question. Research shows that FIP can live in the envi-
ronment for months, but in reality, if you throw away disposable items
that the sick cat used and clean any other inanimate objects with a solu-
tion of 1 part bleach to 10 parts water, the risks of transmission are slim.
222 Guide to a Healthy Cat

    I think the best new animal is an unrelated kitten or cat who is at
least 16 weeks old and appears hearty and healthy. But unfortunately,
there are no guarantees with FIP.

Rabies is a virus that can affect any warm-blooded animal. In certain
parts of the country, rabies is present in a large number of wild animals,
so the risk of exposure to outdoor cats is high. Skunks, bats and many
other animals can carry rabies but not develop outward signs of disease.
Depending on where you live, laws may mandate that your cat be vac-
cinated against rabies.
    Animals infected with rabies usually die within weeks of infection,
because the virus attacks cells in their brains.

Vaccinating Against Rabies
The recommended protocol for immunizing a cat against rabies is to
give the first vaccine at three to four months of age, repeat the vaccine
one year later, and then revaccinate every three years. Some states
require a different schedule, and your veterinarian will know the law in
your area. If a rabies vaccine is not legally required in your state and
your cat does not go outdoors, it can be an optional vaccine. But if your
cat does go outdoors, you should consider vaccination whether or not
it’s legally required in your state.
      You might also consider vaccinating your cat against rabies if the cat
is aggressive and ever bites humans. If a bite wound requires medical
attention, the doctor performing the treatment is required to report the
bite to local animal control authorities. Any animal who bites a human
is placed under some type of quarantine, but unvaccinated animals are
placed under stricter rules.

Signs of Rabies
People occasionally joke about “looking like a rabid dog”—this expres-
sion is used to describe somebody or something with wide-open eyes
and drool on their lips. In fact, these are actual clinical signs seen in cases
of rabies. Because rabies affects the brain, seizures, blindness, clumsiness,
drooling and behavioral changes are seen in afflicted animals. I hope
none of you ever come in contact with a rabid animal, because if there
                                                 The Dreaded Viruses   223

is any risk that exposure has occurred, humans have to go through a
battery of multiple, painful injections.
    As gruesome as it sounds, the suspicious animal must be dead to
definitively diagnose rabies.The diagnosis is made by observing charac-
teristic microscopic changes in the animal’s brain.

Feline panleukopenia is actually feline parvovirus.The incidence of this
disease is extremely low because of the effectiveness of the currently
available vaccines.Today the infrequent cases that are seen occur in stray
cats or cats in animal shelters who have never been vaccinated.
Panleukopenia is a component of kitten vaccines and the basic booster
shot that most adult cats receive.

Signs of Panleukopenia
Cats infected with this virus can have fevers and diarrhea that do not
respond to treatment.Anorexia, vomiting and lethargy are other possible
signs. It takes a few weeks after an animal is vaccinated for protective
immunity to be conferred, so a kitten who was recently vaccinated
could still be at risk.

Testing for Panleukopenia
The definitive diagnostic test for panleukopenia is an extremely low
white blood cell count.The term panleukopenia actually breaks down as
pan (all), leuko (white cells), penia (low count). Another way this virus
can be diagnosed is by doing a canine parvovirus test on an affected cat’s
stool or blood.The viruses are so similar that the test can diagnose both.

What’s the Prognosis?
Most cats with panleukopenia die from the virus, but if the disease is
diagnosed early and the animal receives enough supportive care, there
is a chance of recovery.The virus attacks the rapidly growing cells in the
body, so the stomach, intestines, heart and brain are the organs most
affected. Supportive care is aimed at maintaining hydration and elec-
trolyte balance, controlling vomiting and diarrhea, treating secondary
bacterial infections and keeping up the blood cell count.
Chapter 22

Understanding Diagnostic

In this chapter I will explain common and not-so-common diagnostic
testing. A thorough history and physical exam are crucial to a diagnosis,
but more evidence is often needed to reach a conclusive answer (which
veterinarians call a definitive diagnosis). Diagnostic testing provides this
evidence.There are a host of different tests that may be needed, depend-
ing on the clinical signs a cat is exhibiting. It is important to have a basic
understanding of the costs, risks and benefits of performing certain tests,
so that you can make good decisions about your cat’s care.

There are two basic ways in which feces is examined in a veterinary
clinic: fecal flotation and direct smear.To rule out intestinal parasites, it
is recommended that up to three separate fecal analyses be performed.
Fecal examination should be performed on all kittens and on any cat
with vomiting and/or diarrhea.A fecal exam should also be run at least
once a year on all cats who go outdoors.

                                       Understanding Diagnostic Testing   225

     In a flotation test, stool is mixed with a fluid that causes eggs and
protozoa to rise to the top of the mixture.The material is transferred to
a slide or coverslip, which is examined under a microscope. In a direct
smear, a swab transfers a small amount of stool to a slide, where it is
mixed with a drop of saline solution and smeared. The slide is then
examined under a microscope.A smear reveals certain protozoa, such as
giardia, and bacteria.

Unfortunately, we cannot hand cats a cup and ask them to provide us
with a urine sample. Urine is obtained in several ways: collecting from
a litter box, expressing the bladder, passing a urinary catheter, and cys-
tocentesis (inserting a needle through the body wall into the bladder).
Although cystocentesis sounds like an aggressive way to get a sample,
it is the preferred method and the only way to get a sterile sample if
a culture is needed. If your cat’s bladder is empty when a urine sam-
ple is needed, you may be asked to leave your cat for several hours
until enough urine builds up for collection, or to come back for
another try.
     I never have cat owners get urine samples, because there’s too
much risk of contamination and improper storage of the sample.At the
clinic we prefer to obtain urine through cystocentesis, and a sterile
sample obtained through cystocentesis is needed for culture. Most
male cats can be catheterized through their urethra if we cannot get a
needle into the bladder. Sometimes I manually express a bladder and
get a “free catch” sample. If you are trying to get a sample at home,
sometimes cats will urinate into an empty plastic litter box. A com-
mercial litter of plastic beads can replace normal litter at home to get
a sample you can pour off.
     Most veterinarians perform urinalyses in their clinic, but they may
also send samples out to a laboratory. One component of a urinalysis
tests the concentration of the urine. Cats normally have very concen-
trated urine, with specific gravity above 1.040. Concentration is deter-
mined by kidney function and water intake.
     A dipstick is used to check urine for pH, chemistry values such as
glucose, and blood.The urine is spun in a centrifuge and the sediment
is examined under a microscope to look for crystals, cells and bacteria.
If infection is suspected, the urine is cultured for specific bacteria.
226 Guide to a Healthy Cat

The blood carries information about numerous body systems and organ
function.Values can change quickly, depending on what is being measured,
so a blood panel is a snapshot of what is going on inside a cat’s body at
a particular time. Blood tests are not directly useful for evaluating the
central nervous system, intestinal function or bladder disease.
    Many veterinary clinics have machines capable of doing some
blood tests, but all clinics send at least some samples out to a reference
lab.When results are conclusive, blood tests are wonderful for support-
ing a diagnosis. Unfortunately, cats don’t always do what they are sup-
posed to, and results may not fit with the suspected disease.
    Reference ranges are the values that have been established as normal
for a particular test on a particular machine. Often healthy cats have val-
ues outside of these ranges. The significance of a test result above or
below the reference range depends on the particular test. Minor eleva-
tions are significant in some situations, while in others a value might need
to be at least two times above normal to be important. Results always
need to be interpreted based on a cat’s condition and clinical signs.
    Blood samples are obtained from the blood vessels.The amount of
blood needed to perform tests depends on the number of tests run and
the equipment used. Many in-house blood chemistry tests can be per-
formed with a few drops of blood obtained through a leg vein. A full
panel sent to a lab requires several milliliters of blood, usually obtained
through the jugular vein.

CBC stands for complete blood count, and this includes white blood
cells, red blood cells and platelets. White blood cells respond to infec-
tion and inflammation. There are five types of white blood cells: neu-
trophils, monocytes, lymphocytes, eosinophils and basophils. Red blood
cells carry nutrients and oxygen to other cells in the body. Platelets are
important for blood clotting.
     All of the blood cells are produced in the bone marrow and released
based on the body’s need and normal aging of the cells. The different
blood cells respond to injury and other disease states within the body
in ways that are reflected in their counts.
     Not every cat with an infection will have an elevated white blood
cell count. In fact, viral infections often cause low white blood cell
counts. Allergic reactions and parasites can cause elevations in feline
eosinophil (a specific type of white blood cell) levels. Cats with cancer
                                        Understanding Diagnostic Testing   227

can have high neutrophil cell (another type of white blood cell) counts.
These are a few examples of information a CBC can provide.

Blood Chemistries
There are numerous blood chemistry tests available, and those used
most frequently are typically packaged together as a panel to evaluate a
patient.Although each test has individual significance, it is important to
look at the whole panel, since some tests are best understood in rela-
tion to others. I will touch on the most common tests.
     Tests that relate to the liver are ALT (alanine aminotransferase) also
known as SGPT (serum glutamic-pyruvic transaminase),AST (aspartate
aminotransferase), alkaline phosphatase, and total bilirubin. ALT and
AST are “leakage enzymes,” released when the liver is infected,
inflamed or diseased. The values do not necessarily correlate to the
amount of liver damage. Alkaline phosphatase becomes elevated when
there is liver disease, especially when bile flow is impaired. Bilirubin
becomes elevated with liver disease and when red blood cells break
apart within the body (hemolysis). Increased circulating bilirubin is
responsible for jaundice. GGT (gamma-glutamyl transferase) is another
enzyme linked to bile flow obstruction or administration of cortisone
in some cats. These tests all tell a vet that the problem is the liver, but
do not show the specific cause of liver disease.
     Proteins are synthesized within the body and are present in the
blood.When blood protein levels are low, this indicates lack of protein
production or a loss through the GI or urinary tracts. Protein is sepa-
rated into two components: albumin and globulin.Albumin is necessary
to keep fluid within the blood vessels and to carry other compounds
within the blood. Globulins are antibodies produced by white blood
cells. High globulin levels are seen in dehydrated patients and those
with infections.
     Kidney function is assessed through BUN (blood urea nitrogen) and
creatinine values. These values rise when more than two-thirds of kid-
ney function is compromised. BUN and creatinine are also affected by
the hydration status of the patient, blood flow through the kidneys and
urinary tract blockages. Osmolality is a value based on electrolyte values
in the blood and also relates to the kidneys’ ability to concentrate urine.
     Blood glucose is important in assessing starvation, stress and diabetes
mellitus. In healthy cats the value varies but remains within the refer-
ence ranges, depending on what and when the animal eats.
     Electrolytes are minerals present within the blood.They are neces-
sary for some body functions. Calcium is needed to relax and contract
228 Guide to a Healthy Cat

the heart muscle. Potassium is also needed for heart muscle relaxation
and general muscle contraction. Sodium and chloride are essential
for fluid balance within the body. Phosphorus is needed for energy
reactions and regulating the metabolism of bone. Phosphorus levels
are elevated in cats with chronic kidney disease. Magnesium is a min-
eral that can be elevated in neuromuscular or heart disease, but rarely
shows up as an imbalance in a cat’s blood. Disease states such as dehy-
dration, vomiting and diarrhea can all affect the body’s electrolyte
    CPK (creatine phosphokinase) is an enzyme that is released during
muscle exertion and trauma. It can elevate in anorexic cats when they
break down muscle proteins for energy.

Thyroid Tests
T4 is the active thyroid hormone routinely measured in cats to test for
hyperthyroidism. Low thyroid levels are only rarely found in cats, but
high levels are common in cats nine years and older. T4 levels can be
suppressed when other diseases are present, and hyperthyroidism is then
masked. Currently, a test called T4 by equilibrium dialysis is used to
confirm a diagnosis of hyperthyroidism when regular T4 results are
inconclusive but clinical signs suggest the thyroid is the problem.

Cholesterol and triglyceride levels are often reported on blood panels.
They relate to fat metabolism, but high cholesterol is not a danger and
does not cause arteriosclerosis in cats.These values are often elevated in
cats with liver disease or diabetes mellitus.

Pancreatic Enzymes
Amylase and lipase are two enzymes produced by the pancreas. In dogs
they are fairly reliable indicators of pancreatitis, but this is not true in
cats. Currently it is believed that these values do not relate to any dis-
ease or problems in cats.

Viral Tests
There are reliable diagnostic tests for the feline leukemia (FeLV) and
feline immunodeficiency viruses (FIV).There is also a test for feline coro-
na virus (FCV) that is used to support a diagnosis of feline infectious
                                        Understanding Diagnostic Testing   229

peritonitis (FIP), but alone is not diagnostic. Any positive test should be
confirmed by other means.
     FeLV is initially screened through an ELISA (enzyme-linked
immunosorbant assay) test for viral antigens in the blood.The confirming
test is an IFA (immunofluorescent antibody) that detects viral antigens
associated with cells. When both tests are positive, the cat is likely to be
persistently infected with FeLV.When there is a discrepancy in the results
(one positive, one negative), the tests should be repeated in 60 days and
then annually until they concur. Discordant results may reflect the stage of
     FIV is initially screened through an ELISA test that detects antibodies
against the virus in the blood. Most cats develop antibodies within 60 days
of infection. A western blot test confirms the diagnosis of FIV by show-
ing that the antibodies are specific to FIV structural proteins. There are
PCR (polymerase chain reaction) tests for FeLV and FIV viral RNA or
DNA, but currently these tests have not been standardized or validated.
     FIP cannot be definitely diagnosed by any blood test.The tests used
that may support a diagnosis are an antibody titer test to FCV, FIP 7B
ELISA and FIP PCR, but none of these are conclusive blood tests.

X rays are diagnostic images, also called radiographs.They are produced
on film, and now also digitally, when a beam of electromagnetic ener-
gy is transmitted through part of the body and the image it creates is
captured.The density of various tissues affects the way the energy beam
relays the image. X rays are very good for evaluating bony structures
and of variable usefulness for soft tissue structures. They are excellent
for detecting metal and rubber objects inside a cat’s body.
    X rays provide a two-dimensional image of a three-dimensional
animal, so at least two views are needed to properly assess a body part.
X rays are a relatively inexpensive test and are readily available in vet-
erinary hospitals.
    When patients are fairly cooperative, animal technicians wearing
protective aprons and gloves position and hold the animal during expo-
sure. Fractious animals, or those in pain, require sedation or anesthesia
for proper images to be recorded.
    Contrast materials make visualization of certain body parts clearer
on X rays. In a barium upper GI series, a cat is made to drink a chalky
liquid that outlines his esophagus, stomach and intestines as it passes
through. Some abnormalities in the lining of the tubular GI tract and
obstructions are found this way.
230 Guide to a Healthy Cat

    Another type of contrast X ray is a pneumocystogram. In this type
of X ray, a catheter is placed through the urethra into the bladder. Urine
is drained out and air is instilled.The air provides contrast to the blad-
der wall and helps in visualizing the bladder lining and stones.

Sound waves transmitted through body tissues produce ultrasonic
images. Ultrasound is an imaging technique that is better for evaluating
many of the soft tissue structures that are not well defined by X rays.
The most common uses for ultrasound are to evaluate the heart
(echocardiogram) and the abdominal cavity.
    An echocardiogram is necessary to evaluate heart disease in cats.
This test can to measure the size and shape of the heart chambers, eval-
uate blood flow through the heart and the functioning of the valves,
and see through any abnormal fluid buildup in the chest cavity.
    Abdominal ultrasound evaluates the liver, gall bladder, bile ducts,
stomach, kidneys, spleen, bladder, intestines and lymph nodes. It can
provide guidance for needle biopsies of organs. Most cats will tolerate
ultrasound without sedation. Shaving the body part to be evaluated is
necessary to obtain the best image.
    Many private practitioners offer ultrasound in their hospitals.
Specialists and referral centers also provide the service.

Fiber optic scopes provide images of body parts that may not be easily
reached without invasive surgery.The scope is a flexible camera that can
enter into areas inside an animal. A scope can give your veterinarian a
direct look at internal tissue and guide a pinch biopsy or retrieve small
objects from the nose, main airways, esophagus, stomach, intestine or
colon, depending on its size.
     Proper endoscopic evaluation requires general anesthesia and good
technique. The test is typically performed without a hospital stay.
Endoscopy is less invasive than surgery, but limited in the areas where
it can be used and the size of biopsies obtained.

A biopsy is a piece of tissue that is evaluated microscopically.There are
three common types of biopsies: needle, pinch and full thickness.
                                        Understanding Diagnostic Testing   231

     There are two kinds of needle biopsies. Fine needle aspirates
obtained through palpation or guided by ultrasound, and tru-cut guid-
ed by ultrasound. The number of cells obtained by a fine needle aspi-
rate is small and may not be diagnostic.Tru-cut needles are fairly large
and take a small core of tissue. The larger the needle, the more risk of
bleeding and tissue damage, but also the higher likelihood of obtaining
a diagnostic sample.
     Pinch biopsies are obtained when a small sample is grasped and pulled
manually with a hemostat or through a special tool used in conjunction
with an endoscope. Pinch biopsies are usually larger than needle biopsies.
     Surgery is used to obtain full thickness biopsies. A wedge of tissue
is taken in most situations. A thin slice is taken for intestinal biopsies.
Full thickness biopsies are the most diagnostic, since they contain the
largest amount of tissue.
     When tissue biopsies are submitted to a lab, they are preserved in
formalin, embedded in wax, cut into microscopic sections, affixed to a
slide, stained and read by a pathologist. The process takes two to five
days. Certain conditions may require special stains be applied to tissues
in order to make a diagnosis. Interpreting biopsy results should be based
on the clinical signs of the patient, because the pathologist’s assessment
is subjective.

Cytology is another way to microscopically examine cells that is less inva-
sive for the patient than a biopsy.With cytology, cells are placed on a slide
and read in a veterinary hospital or sent to a lab for pathologist review.The
cells come from a needle aspirate of a mass or tissue, a swab of tissue or an
organ (such as a vaginal smear to evaluate a heat cycle), or from an impres-
sion smear (placing a slide directly on material you want to examine).
     Results are immediate or can take a day, depending on whether the
sample is sent out to a lab. Unfortunately, cytology samples are not
always diagnostic, and sampling needs to be repeated or a biopsy taken
when results are inconclusive.

This test is commonly called an ECG or EKG, and is a record of the
electrical activity of the heart. Electrical activity relates to heart func-
tion and is tested by attaching clips to certain parts of the body and
measuring the electrical impulses. Most cats will not tolerate clips
232 Guide to a Healthy Cat

                                              if they are not sedated. Some
                                              newer technology replaces clips
                                              with a contact plate, but these
                                              machines currently are not
                                              routinely reliable for measuring
                                              cats. The electrical impulses
                                              produced by cats are weak and
                                              difficult for devices to pick up.

                                              BLOOD PRESSURE
                                                Getting a diagnostic blood
                                                pressure reading in cats requires
                                                practice and a relatively calm
A small cuff around the leg is inflated as part
of a blood pressure measurement.                patient. It is easy to practice but
                                                not always easy to relax a cat in
                                                a veterinary clinic. There are
various ways for measuring blood pressure, but the most widely used
technique uses a Doppler device. Dopplers use sound waves to measure
blood flow.
     In cats only systolic readings are used to evaluate blood pressure.
Systolic measurements correlate with heart muscle contraction. At this
time, reliable diastolic measurements cannot be routinely obtained non-

A cerebral spinal fluid tap is used to obtain a sample of the fluid that
bathes the brain and spinal cord.Anesthesia and skill are needed to get a
diagnostic sample. Cerebral spinal fluid analysis aids in the diagnosis of
many neurological conditions. Most veterinarians refer this procedure to
veterinary neurologists or internists, who perform it frequently, in order
to achieve good results.A needle is placed between two vertebrae at the
base of the skull or in the lumbar region, and about 1.5 milliliters of
fluid is removed for analysis.

A magnetic resonance imaging (MRI) machine uses a computer to
interpret how electromagnetic currents pass through tissue. Specifically,
it measures the differences in hydrogen protons in diseased versus
                                       Understanding Diagnostic Testing   233

healthy cells. MRI is far superior to X rays in evaluating soft tissue
structures, especially the brain, nasal passages and intervertebral disks.
    MRI technology is expensive but is becoming more widely avail-
able in veterinary medicine. Patients must be restrained with anesthesia
to obtain a diagnostic scan, but they are not exposed to significant radi-
ation as with a CT scan (see next section).

A CAT or CT scan uses rotating X-ray beams captured on a detector
to “slice” through the body and examine internal structures. CT scan-
ning is much more sensitive than conventional X rays for evaluating soft
tissue structures, but patients are exposed to more radiation. CT scans
provide more information about bony structures and acute bleeding
than do MRI scans.
     The most advanced CT scanners are able to produce three-
dimensional images of the body. CT scans are expensive but, like MRIs,
they are becoming more widely available in veterinary medicine.

Radioactive compounds can be administered internally and used as a
diagnostic tool. Scintigraphy creates an image of the way certain struc-
tures within the body take up radioactive compounds.This information
can demonstrate the size, shape and location of certain conditions. In
veterinary medicine, scintigraphy is performed at some specialty cen-
ters and veterinary colleges.
    The most common uses of scintigraphy with cats are to evaluate
problems with the bones (chronic lameness or bone tumors that are not
visible on X rays), portal shunts (abnormal blood flow through the
liver), blood flow through the kidneys and thyroid disease.

Our cats are able to benefit from human medical advances to aid in
diagnosing their diseases.Today, reaching a definitive diagnosis is possi-
ble in almost all instances, but the costs involved and the availability of
testing are significant limitations. Unfortunately, even if getting the
answer is possible, treatment may not be. Each cat and situation is
unique, so work with your veterinarian to provide the best practical
health care.
Chapter 23

What Can You Catch
From Your Cat?

Humans have successfully lived with cats for thousands of years, so it
always surprises me when a pregnant woman comes into my office and
tells me she needs to find a new home for her cat. In these situations, I
wonder if her gynecologist has read any medical literature in the last 20
years, because cat ownership is probably one of the smallest risks a preg-
nant woman faces.
     Overall, cats are extremely safe pets to own, and they rarely trans-
mit diseases to humans.You are much more likely to contract a disease
from your friends and family members than you are from a cat. Diseases
that can pass from animals to humans are called zoonoses.
     There certainly are diseases cats can transmit to humans, and I’ve
described some of these, such as giardia, rabies and ringworm, in other
parts of the book. I will shed light on some other transmissible diseases
here, along with the problem facing many people—cat allergies.

                                     What Can You Catch From Your Cat?   235

It is estimated that 15 to 20 percent of the human population may be
allergic to pets. Humans who are allergic to cats can experience a range
of signs, from sniffling and sneezing to life-threatening asthma. Many
cat owners know they are allergic to their pet, but they believe the ben-
efits of cat ownership far outweigh the discomfort of the allergy.
     An allergy is a reaction to a substance that is not inherently harm-
ful. In an allergic reaction, this means the immune system makes anti-
bodies and triggers histamine release. This combination produces an
inflammatory reaction.

How Do You Know It’s the Cat?
If you experience watery eyes, sneezing, sore throat or congestion every
time you are around a cat, chances are you are allergic to cats. However,
if you have cats and are having an allergic reaction whenever you’re
home, it doesn’t necessarily mean the cat is the culprit. You may be
allergic to dust or mold or the houseplant on your windowsill. Some
allergists assume that if you have a cat and are experiencing allergic
symptoms, you must be allergic to the cat. But the only way to know
for sure is with allergy testing.
     Some people’s allergies worsen over time. Others are only sensitive
when exposed to a large dose of an allergen. For example, you might
be able to tolerate living with one cat but have a terrible time when
you go over to a friend’s home where there are four cats.
     Unfortunately, there are no cures for allergies.Avoiding the allergen
is the best way to prevent problems. However, allergies to things like
dust and trees and grass—which can never be removed from your envi-
ronment—can usually be easily managed. Allergies to cats can often be
managed as well.

Less-Allergenic Cats
Fel-d-1 is the cat allergen that causes most human allergies to cats.This
allergen is found in the skin, oil glands and saliva of cats. Dander is dried
skin that is shed, so Fel-d-1 is spread through dander. All cats lick and
groom themselves, so this allergen can cover their entire body. Since all
cats have skin and saliva, all breeds are potentially allergenic.
236 Guide to a Healthy Cat

     Some people believe allergic people better tolerate the breeds with
little or no hair. Breeds with little hair include Cornish and Devon
Rexes, while the Sphynx is a breed with no hair at all. Longhaired cats
may shed hairs with more dander attached, but their hair is no differ-
ent from that of shorthaired cats.
     Each cat’s chemistry is slightly different, so an allergic person would
have to spend time with any prospective pet to see what their reaction
might be.

Making Life More Bearable
There are some ways to make life easier for an allergic person. If you
are allergic, you should:

     • Wash your hands every time you touch a cat. If you touch
       your face before you wash, you’re asking for trouble.
     • Change clothes after playing with a cat, or have a robe or
       smock that you wear when you’re interacting with a cat.
     • Consider wearing a face mask and protective glasses when
       playing with your cat.
     • Avoid touching cats in the areas where they have the most oil
       glands, such as the chin, cheeks, between the shoulder blades
       and the base of the tail.
     • Never allow cats in your bedroom.There is nothing worse for
       an allergic person than to place their face into a pillow full of
     • Consider using a HEPA filter unit or air purifier to knock
       allergens out of the air.There are also special vacuum cleaners
       with HEPA filters.
     • Wipe the cat down with a damp rag or use a commercial
       anti-allergy pet solution daily or weekly, so that loose allergens
       are removed.
     • Have the cat professionally groomed and well brushed out
       regularly.This will limit allergens on top of shedding hairs.
     • If possible, have just one cat. More cats mean more allergens.
     • Carpet, decorative pillows and draperies can trap allergens, so
       consider replacing them with tile, washable materials, and
       blinds or shutters.
                                    What Can You Catch From Your Cat?   237

     People can work with their allergists to find treatments that help
relieve the symptoms of cat allergies. Allergy shots and antihistamines
are commonly used.There are several antihistamines that can be taken
regularly without side effects or drowsiness. Research is being conduct-
ed today that is looking at other ways the production of antibodies and
release of histamine can be stopped in allergic individuals. In the future,
there may be better options for controlling allergies to cats. Scientists
are even trying to genetically engineer cats without fel-d-1!

Toxoplasma gondii is a protozoan parasite (protozoa are one-celled organ-
isms). Toxoplasmosis, the disease caused by Toxoplasma organisms, can
occur in any human or four-legged animal who ingests one of the infec-
tive stages of the protozoa. This organism has a complicated life cycle,
which requires that it spend some of its development inside a host.
    Humans are frequently exposed to Toxoplasma and don’t even
know it. That’s because the protozoa lives in raw meat, and we can
become infected when we handle the meat. The biggest threat to
humans is when a pregnant woman, during her first trimester, becomes
infected with the organism. An infection at this time can cause con-
genital malformations or mental retardation of the unborn child.
Studies have shown that the vast majority of pregnant women infected
with Toxoplasma got it by handling raw meat.

How Cats Become Infected
Cats become infected with Toxoplasma after they eat raw meat, birds or
mice carrying an infective stage of the organism. Cats shed Toxoplasma
oocysts (the egg stage) in their feces 3 to 10 days after eating infected
tissues.They will shed the oocysts for up to 14 days, and afterward it is
unlikely that they will ever shed them again—even after repeated expo-
sure. Within one to four days of being passed in the feces, the oocysts
become infectious to other animals and humans. Infective oocysts can
live for months in the environment (the litter box or yard, wherever the
cat has defecated).
     If feces are scooped daily and/or if rubber gloves are worn while
scooping, there is little risk of exposure to Toxoplasma from your cat.
Keeping your cat indoors and only feeding commercially prepared cat
food will eliminate the risk of exposure.
238 Guide to a Healthy Cat

     Cats who are infected with Toxoplasma usually do not show any clin-
ical signs and are healthy, although a cat who is also infected with FeLV
or FIV is more likely to become sick. If a cat develops Toxoplasmosis, the
signs of illness can be:

     •   Lethargy
     •   Anorexia
     •   Fever
     •   Diarrhea
     •   Pneumonia
     •   Hepatitis
     •   Uveitis (inflammation of the eye)
     •   Neurological disease

    A blood test that measures antibodies to Toxoplasma is used to diag-
nose the disease in cats. Testing for two different antibodies (Ig G and
Ig M) a few weeks apart and finding rising titers is the best way to make
an accurate diagnosis.

How Humans Are Infected
Humans can become infected if they touch an oocyst, don’t wash their
hands and then touch their mouths. Handling or eating raw meat or
drinking unpasteurized dairy products can also expose people to the
parasite. Healthy humans who are exposed to Toxoplasma may suffer a
brief illness with fever, muscle pain, enlarged lymph nodes, anorexia and
sore throat. People who have compromised immune systems—such as
organ transplant recipients and AIDS patients—need to be as careful as
pregnant women to prevent infection.
    There are many precautions that can be taken to prevent infection:

     • Wear rubber gloves and wash hands thoroughly after outdoor
     • Cover up children’s sandboxes when not in use to prevent cats
       from using them as litter boxes and depositing oocysts.
     • Empty litter boxes daily so that oocysts will not have the
       opportunity to develop to the infective stage.Wear rubber
       gloves for this job or have another family member do it.
                                    What Can You Catch From Your Cat?   239

     • Eat only thoroughly cooked meat and wash your hands vigor-
       ously if you handle raw meat or vegetables.
     • Consume only pasteurized dairy products.
     • Have yourself tested for antibodies to Toxoplasma gondii. If you
       are already positive, there is little risk that you will become ill
       unless your immune system is compromised.
     • Wash your hands after coming in contact with your cat.

     For a pregnant woman to become infected through her cat, an unlike-
ly series of events must occur.The cat must first have recent exposure to
Toxoplasma. Then, the cat’s feces must sit, unscooped, for 3 to 10 days,
while the oocytes become active. Then the woman must actually touch
the feces, and then touch her mouth or nose before washing her hands. In
actuality, it would be extremely rare for a pregnant woman to be directly
infected by a cat.
     If you have an indoor cat who never eats raw meat or goes outside
to hunt and eat birds and rodents, you are essentially at no risk. In fact,
30 to 50 percent of women in the world have been previously exposed
to Toxoplasma.These women develop immunity, and in these situations
there is no risk to a later pregnancy.

Treatment for Toxoplasmosis
There are medications that are effective for treating cats and healthy
humans with Toxoplasmosis. Unfortunately, even if an infected pregnant
woman receives treatment in her first trimester, birth defects cannot be
    We have reached the 21st century, but many physicians are ill-
informed about pregnant women and cats. Any woman considering
pregnancy should know
about Toxoplasmosis. But                    INFECTED MEAT
to hear some doctors talk,
if you want to get preg-          It is estimated that in some parts
nant, you should get rid of       of the world, 10 percent of the
your cat, and this is ridicu-     lamb and 25 percent of the pork
lous. Millions if not billions    are infected with Toxoplasma cysts.
                                  Cows and goats can also be infect-
of women have lived with          ed, so consuming unpasteurized
cats over time and have           dairy products is not recommended.
somehow managed to pro-
duce healthy children.
240 Guide to a Healthy Cat

You may not realize it, but cat scratch fever is more than just a song. It
is caused by Bartonella henselae, a common bacteria found worldwide.
Infection typically occurs when a kitten breaks the surface of a person’s
skin through a bite or scratch. Eighty percent of the cases occur in
people under the age of 21. People who have compromised immune
systems are also at risk for cat scratch disease.
    It is possible that at some time in their lives about half of all cats will
have an infection with Bartonella henselae, and although they appear
healthy, they can carry the bacteria for months. Cat scratches are com-
mon, but fortunately, cat scratch disease in humans is uncommon.

Signs of Cat Scratch Fever
Humans become infected when a kitten or cat scratches or bites them
and injects Bartonella henselae bacteria into their body. It may take two
to three weeks, but a lymph node near the initial injury site will then
swell, and the surrounding tissues will become red and tender. Other
clinical signs that can be seen in humans are:

     •   Fever
     •   Fatigue
     •   Loss of appetite
     •   Headache
     •   Sore throat
     •   Blurred vision
     •   Joint pain

Diagnosis and Treatment
When clinical signs in humans suggest that cat scratch disease is a pos-
sibility, a positive diagnosis is made by:

     • History of exposure to a cat or kitten
     • Tests to rule out other causes of swollen lymph nodes
     • A positive cat scratch disease blood test
                                    What Can You Catch From Your Cat?   241

    In almost all cases, the swollen lymph nodes usually resolve within
a few weeks to months, even without treatment. If you have had a pre-
vious exposure to cat scratch disease, it is unlikely the bacteria will ever
bother you again. People can take anti-inflammatory medications to
help reduce the pain of the swollen lymph nodes.
    In some individuals, the lymph nodes become abscessed and need
to be surgically drained. In these cases, or when individuals with com-
promised immune systems are infected, antibiotics are used. People with
cat scratch disease are not contagious to others.
    If you are concerned about cat scratch disease because of your per-
sonal health problems, there is a test that can check your cat’s blood for
the agent. Because they show no signs of the disease, cats are not rou-
tinely treated with antibiotics. To help prevent cat scratch disease, be
cautious when handling unfamiliar cats, keep your cat’s nails trimmed,
and do not allow your cat to bite or scratch you during interactive play.

Although zoonotic agents have the potential to infect any human,
immunocompromised patients are most at risk for developing severe
disease. Healthy adult, parasite-free, indoor cats are unlikely to pose any
threat to humans.

Cryptosporidia is a protozoal parasite that can potentially pass between
cats and humans. Contaminated water is thought to be the most common
source of human infection, but humans could become infected through
contact with infected cat feces. Eating infected rodents most likely infects
cats. Cryptosporidial infections cause severe diarrhea that can require hos-
pitalization and intravenous fluid therapy for both two- and four-legged
victims. Examining and testing feces can detect the parasite.

Roundworms and Hookworms
Roundworms and hookworms can potentially infect humans. Children
can accidentally ingest roundworm eggs if they play in sandboxes or
dirt contaminated by dog or cat feces. Eggs hatch in their intestines, and
larvae can then penetrate the intestinal wall and invade other tissues.
The condition is called visceral larva migrans.
242 Guide to a Healthy Cat

    Hookworms are transmitted to humans if their skin comes in direct
contact with moist soil or sand contaminated with larvae.The parasite
migrates through the skin and leaves a trail of inflammation.This con-
dition is called cutaneous larva migrans.

Cats can carry Salmonella, a bacterium capable of causing severe gas-
trointestinal disease. Cats who eat infected birds or raw meat are at risk
for infection. Fortunately, very few cats become infected with Salmonella;
a recent study in Colorado found only about 1 percent of cats were
infected. Human exposure is prevented with good hygiene and sanita-
tion around feces.

If you know history, you may know that epidemics of bubonic plague
have occurred around the world. But did you know that plague occurs
in random cases in the United States each year? Infrequent cases have
occurred in New Mexico, Arizona, Colorado and California. The last
epidemic in the United States was in Los Angeles in 1924 and 1925.
Fortunately, there have only been 8 to 20 human cases annually in the
United States over the past 10 years.
    Bubonic plague gets its name from bubo which is a swollen, hot lymph
node. Plague is caused by the bacteria Yersinia pestis, and is transmitted from
rodent to rodent by fleas. Rock squirrels, ground squirrels, prairie dogs,
wood rats and chipmunks are other commonly infected species.
    Cats can become infected with plague by infected fleas or by
ingesting an infected rodent, and infected cats are possible sources of
infection to humans.
    Aside from direct flea bites, plague can be transmitted through a
skin wound and contact with fluids of an infected animal. Inhaling
droplets in the air that are produced when an infected animal coughs
can also transmit plague.
    The most characteristic clinical sign of plague is the presence of
bubos. Fever, headache, general illness and exhaustion accompany these
painful, swollen, hot lymph nodes. The progression of disease is very
rapid, and occurs within two to six days of exposure. Bacteria can
invade the bloodstream and produce potentially fatal plague septicemia.
    Once bacteria enters the blood, it can go to the lungs and cause
pneumonia. If antibiotic treatment is not initiated in time, death can
result. Half of all of humans who develop plague pneumonia die.
                                    What Can You Catch From Your Cat?   243

   People most at risk are Native Americans, campers, hikers and
hunters who may travel in plague areas, as well as veterinarians and pet
owners. Use caution if you live in a plague state and your cat exhibits
bubos or pneumonia, and contact your veterinarian immediately.

I included this last chapter as an information resource to help dispel
myths surrounding diseases that cats may transmit. Unfortunately, some
people are allergic to cats, but aside from this problem, the likelihood of
any other health problems arising from cat ownership is extremely low.
    Owning a cat will enrich your life and offer far more benefits than
risks. Cats are wonderful additions to the family who really do want and
need us. Studies show that on average, pet owners live longer than peo-
ple without pets. I know that after a long day at the office, there is noth-
ing I like better than to cuddle with one of my cats and have him purr
in my ear! Cats are super stress relievers.They are curious, mischievous
and very entertaining to watch.They also do a good job of ridding your
house of bugs.
    Most cats require little care and live long lives. They can easily fit
into our busy lives or be constant companions. If you’ve made it to this
part of the book, you have the tools you need to keep your cat healthy
and enjoy a long life together.
Appendix A

Glossary of Veterinary
and Cat Terms

abscess A hole filled with pus and surrounded by infected tissue.
acute A disease that begins quickly.
adulticide A product that kills adult insects.
allergen A foreign substance that causes an allergic response in
    some animals.
alopecia Hair loss.
anaphylaxis A severe and potentially fatal allergic reaction that
    causes fever, redness and difficulty breathing.
anemia Low red blood cell count.
anorexia Lack of appetite for food.
anterior drawer sign Laxity present in the knee when the
    anterior cruciate ligament is damaged.
antibody A protein produced in the body as a response to contact
    with another foreign protein.
antigen A foreign substance that causes the body to produce an

246 Glossary of Veterinary and Cat Terms

arrhythmia Irregular heartbeat.
atopy Inhaled allergy.
auscultation Listening to the heart and lungs with a stethoscope.
benign Harmless.
bilateral On two sides.
biopsy Removing tissue for microscopic examination and diagnosis.
brachycephalic Flattened facial structure, characteristic of
    Persian cats.
bubo A swollen, hot lymph node.
cancer Cells whose growth is uncontrolled.
cardiomyopathy Heart muscle disease.
carnivore A meat-eating animal.
castration Removing the testicles.
catnip A plant in the mint family that has hallucinogenic effects
    on cats.
cattery A facility where cats are bred.
chitin A protein found in insect skeletons.
cholagiohepatitis Inflammation of the bile ducts and liver.
chronic A disease that develops slowly or persists for a long time.
coccidia A type of protozoal parasite of the gastrointestinal system.
colostrum The antibody-rich first milk an animal produces.
congenital A condition a cat is born with.
conjunctivitis Inflammation of the tissue around the eyeball.
corneal ulcer An abrasion or scratch on the surface of the eye.
cryotherapy A medical procedure that freezes tissues.
cryptococcus A type of fungus.
cryptorchid A cat with one or both testicles retained.
cystitis Inflammation of the bladder.
cytology Microscopic evaluation of cell structure.
dermatophytes A group of fungi capable of causing ringworm.
dialysis A process where a body fluid is removed from the body
    and cleaned.
diaphragm The muscular band that separates the chest and
    abdominal cavities.
diastole Blood pressure when the heart relaxes.
dietary indiscretion Eating something other than food.
diuresis A process that causes the body to produce and eliminate
    more urine.
dystocia Difficulty during the birthing process.
                                 Glossary of Veterinary and Cat Terms   247

ECG An electrocardiogram, which measures the electrical activity
    of the heart.
echocardiogram A test that evaluates the heart using sound waves.
EEG An electroencephalogram, which measures the electrical activ-
    ity of the brain.
estrous cycle The normal four-stage fertility cycle in a female cat.
foreign body A substance that is not supposed to be located where
    it is found.
giardia A type of protozoal parasite of the gastrointestinal system.
gingivitis Inflamed gums.
hepatic lipidosis A disease of the liver caused by too much fat
hernia A protrusion of an organ through a tear in a muscle.
hip dysplasia Poor conformation of the hip joints.
holistic A system of total patient care that considers physical,
    emotional, social, economic and spiritual needs.
housesoiling When a cat eliminates inappropriately outside of a
    litter box on a horizontal surface.
hypertension High blood pressure.
hyperthyroid Having an overactive thyroid gland.
hypoglycemia Low blood sugar.
hyposensitize Decrease an allergic response by injecting antigens.
idiopathic Occurring for no known cause.
incontinence Loss of control of a body function.
inguinal Near the groin.
intact A cat who has not been spayed or neutered.
interstitial cystitis A benign inflammatory condition of the
jaundice A yellowish discoloration of tissues due to bile pigments
    in the blood.
lesion A change or injury to a body tissue that impairs the tissue or
    causes a loss of function.
lethargy Feeling indifferent or sluggish.
luxating patella A kneecap that pops out of joint.
malignant A tumor that can invade other tissues and/or spread
    through the bloodstream.
mastectomy Surgically removing an entire mammary gland.
maternal immunity Protective antibodies received from the ani-
    mal’s mother through nursing.
248 Glossary of Veterinary and Cat Terms

megacolon Abnormal widening of the large intestine that causes
   constipation in cats.
metastasize When a cancer spreads from its original site to another
   part of the body.
miliary dermatitis A crusty, scaly skin condition.
mutation A change that occurs within a gene.
nebulization A process that creates an aerosol mist.
neoplasia An abnormal growth of new tissue.
neuter Removing an animal’s sex organs.
nocturnal Something that functions or is active at night.
oncologist A doctor who specializes in treating cancer.
ovariohysterectomy Surgical removal of the uterus and ovaries.
palpation Using the fingers and hands to examine parts of the body.
pectus excavatum A congenital bone abnormality causing a
   flattened ribcage.
pericardium The sac that surrounds the heart.
peritonitis Inflammation within the abdominal cavity.
pheromone Chemical signals that are present in different animal
pleural effusion A build-up of fluid in the chest cavity.
polydactyl Having more than the normal number of toes.
polyestrus Able to have multiple estrus cycles throughout the year.
prostaglandins Special fatty acids that can act like hormones.
protozoa A type of single-celled organism.
pulmonary edema A build-up of fluid in the lungs.
pyometra An infected, pus-filled uterus.
queen A mother cat.
radioisotope An element that gives off radiation.
renal Having to do with the kidneys.
rhinoscopy Examination of the back of the nasal passages with a
   fiber optic scope.
seasonally polyestrus During certain seasons of the year, cats can
   go through their heat cycles multiple times.
spay Surgically removing the uterus and ovaries.
spray Depositing urine on a vertical surface.
squamous cell carcinoma A type of skin cancer.
subcutaneous Having to do with the tissue under the skin.
                                 Glossary of Veterinary and Cat Terms   249

systole Blood pressure when the heart contracts.
tomcat An intact male cat.
trichobezoar A hairball.
turgor The normal strength and tension of the skin created by
unilateral On one side.
urohydropropulsion A technique for forcing small stones out of
    the bladder.
urolith A stone in the urinary tract.
uveitis Inflammation of the iris, choroid and ciliary body of an eye.
vascular Having to do with blood vessels.
zoonosis A disease that can pass from animals to humans.
Appendix B

Where to Learn More

  ASPCA Animal Poison Control Center
  (888) 426-4435
  $45 per case, credit cards only

Poisonous plant guides

252 Where to Learn More

   American Animal Hospital Association (AAHA)
   12575 West Bayaud Avenue
   Denver, CO 80215
   (303) 986-2800

   American Association of Feline Practitioners (AAFP)
   618 Church Street, Suite 220
   Nashville,TN 37219
   (615) 259-7788

   American Veterinary Medical Association (AVMA)
   1931 North Meachum Road Suite 100
   Schaumburg, IL 60173
   (847) 925-8070

   Cornell Feline Health Center
   College of Veterinary Medicine
   Cornell University
   Ithaca, NY 14853
   (607) 253-3414
Appendix C

Pet Loss Grief Counseling
Hot Lines

Chicago Veterinary Medical Association Pet Loss Hotline
(630) 603-3994
Leave voice mail message; calls will be returned 6 P.M. to 8 P.M. (CT)
Long distance calls will be returned collect
Colorado State University’s Argus Institute Family Support Services
(970) 491-1242
Offers individual and group counseling
Companion Animal Association of Arizona’s Pet Grief Support Hotline
(602) 995-5885
24 hours a day

254 Pet Loss Grief Counseling Hot Lines

Cornell University College of Veterinary Medicine Pet Loss Support
(800) 253-3932
Tuesday to Thursday, 6 P.M. to 9 P.M. (ET)
Messages will be returned
Iams Pet Loss Support Center and Hotline
(888) 332-7738
Monday to Saturday, 8 A.M. to 8 P.M.
Iowa State University Veterinary Teaching Hospital Pet Loss Support
(888) 478-7574
Operational seven days a week, 5 P.M. to 8 P.M. (CT)
Michigan State University’s College of Veterinary Medicine Pet Loss
(517) 432-2692
Tuesday to Thursday, 6:30 P.M. to 9:30 P.M. (ET)
Long distance calls will be returned collect
The Ohio State University’s Pet Loss Hotline
(614) 292-1823
Monday,Wednesday and Friday, 6:30 P.M. 9:30 P.M. (ET)
Voice mail messages will be returned collect during operating hours
Tufts University Pet Loss Support Hotline
(508) 839-7966
Weekdays 6 P.M. to 9 P.M. (ET)
Voice mail messages will be returned daily, collect outside of Massachusetts
University of California–Davis Pet Loss Support Hotline
(800) 565-1526
Weekdays, 6:30 P.M. to 9:30 P.M. (PT)
                                  Pet Loss Grief Counseling Hot Lines   255

University of Florida Pet Grief Support Hotline
(352) 392-4700, ext. 4080
7 P.M. to 9 P.M. (ET)
University of Illinois’ College of Veterinary Medicine’s CARE Pet Loss
(877) 394-2273
Leave voice mail message; calls will be returned 6 P.M. to 8 P.M. (CT)
Sunday,Tuesday and Thursday
Long distance calls will be returned collect
University of Pennsylvania’s School of Veterinary Medicine’s Pet Loss
Support Hotline
(215) 898-4529
Weekdays, 9 A.M. to 5 P.M.
Virginia-Maryland Regional College of Veterinary Medicine Pet Loss
Support Hotline
(540) 231-8038
Tuesday and Thursday, 6 P.M. to 9 P.M. (ET)
Washington State University’s Pet Loss Support Hotline
(509) 335-5704
24-hour voice mail and staffed Monday, Tuesday and Thursday, 4 p.m.
to 6:30 p.m. (PT), and Saturday 10:30 A.M. to 12 P.M.
About Elaine Wexler-
Mitchell, D.V.M, ABVP

Dr. Wexler-Mitchell obtained a bachelor of science degree from
Cornell University and then went on to the Virginia-Maryland
Regional College of Veterinary Medicine to earn her doctorate in
veterinary medicine. After working in general small animal practice for
five years, she opened The Cat Care Clinic in Orange, California, in
1991. She became board certified in feline practice through the
American Board of Veterinary Practitioners in 1995, one of the 24
charter diplomates. She is a member of many veterinary organizations,
including the American Association of Feline Practitioners, AVMA,
AAHA, SCVMA, CVMA, and she is a former past president of the
Academy of Feline Medicine.
    Dr.Wexler-Mitchell is a feature writer, columnist, and contributing
editor to Cat Fancy magazine. In addition to lecturing about cat care,
she has appeared numerous times on television and radio. She has served
as an appointed member of the Orange County Animal Control
Advisory Board.
    In her free time, Dr. Wexler-Mitchell enjoys tennis, golf, yoga,
skiing, and traveling. She lives with her husband, Howard, and her two
Somali cats, Keiki and Shaka.
    More information about Dr.Wexler-Mitchell and her clinic can be
found at
abscesses, 74, 160                               annual physical exam, 67, 71–80
Abyssinians, 166, 211                            annual vaccination, 82
acne, 153–154                                    anorexia, 47–48, 145–146, 213, 223
acute retinal detachment, 194                    anterior cruciate ligament (ACL), 178
Addison’s disease, 189                           anterior drawer test, 178
adrenal gland disease, 189                       anterior uveitis, 193
adult cats, 15, 43–44, 51, 91                    aortic thrombosis, 169
Aelurostrongylus abstrusus, 134                  arginine, 41
aggression, 23–24                                arteriosclerosis, 119
alanine aminotransferase (ALT), 227              arthritis, 122, 173–175
albumin, 227                                     aspartate aminotransferase (AST), 227
alkaline phosphatase, 227                        Association of American Feed Control
allergens, 151                                     Officials (AAFCO), 39
allergies, 126, 132, 150–153, 193                asthma, 120, 131–133, 170
alpha interferon, 128                            auscultation, 166–167
alpha-linoleic acid, 42                          autoimmune hemolytic anemia, 165
AltVetMed Web site, 70                           autosomal dominant gene, 179
aluminum adjuvants, 93                           AVMA Web site, 69
American Association of Feline Practitioners
  (AAFP), 68, 83                                 bacterial infections, 129–130
American Association of Feline Practitioners     bad backs, 198–200
  Web site, 65                                   baldness, 153
American Board of Veterinary Practitioners       baths, 34–35, 57
  (ABVP), 68                                     bee stings, 56, 158
ammonium stones, 206                             behaviors, 15–16,18, 51, 94–95, 97–98,
amputation, 177                                    100-101, 103–104, 111, 140
amylase, 228                                     Bengal cats, 180
anal glands, 148                                 benign inflammatory polyps, 158
anaphylactic reaction, 56, 158                   bezoar, 31
anemia, 164–165, 213                             bilateral cyptorchid, 99
anestrus, 14, 104                                biopsies, 160, 230–231
anger, 23–24                                     Birman, 166

258 Index

birth control, 107–108                        chiropractic, 70
bladder, 201–202, 206–208                     Chlamydia felis, 87
bleeding, 162–164                             Chlamydia (pneumonitis), 84, 192
blindness, 193–194                            Chlamydia trachomatis, 87
blood, 140, 162–163, 166, 212–213             Chlamydia vaccines, 87–88
blood chemistries, 227–228                    chlorpheniramine, 56
blood glucose, 227                            cholagiohepatitis, 146–147
blood pressure, 232                           cholesterol, 228
blood tests, 226                              chronic diseases, 130
blood urea nitrogen (BUN), 116, 210, 227      chronic renal failure, 115–116
bloody nose, 126                              chronic tubulointerstitial nephritis,
bloody urine, 202–203                           211–212
bone marrow, 164                              Chyletiella, 156
bones, 172, 179–180                           circulatory system, 161–162
Bordetella bronchiseptica, 84, 89             claws, 28–29
Bordetella vaccine, 89–90                     cleft palate, 110
boredom, 17–18                                coccidia, 77–78
brachycephalic face, 179                      cognitive dysfunction, 26, 119–120
brain, 190                                    colds, 128–131
brain stem auditory evoked response (BAER)    colostrum, 10, 83, 108
  testing, 194                                combing, 29–30, 32
breast cancer, 188–189                        complete blood count (CBC), 226–227
breeding, 101                                 compounding pharmacies, 60–61
British Shorthair, 166                        computer-assisted tomography (CAT) scan,
broken bones, 176–177                           119, 233
bronchi, 131                                  congenital defect, 102
bronchitis, 127, 131                          congenital heart diseases, 166, 168
bruising, 164                                 congenital shunts, 147
brushing, 29–30, 32                           conjunctivitis, 86, 192–193
brushing teeth, 75                            constipation, 55–56, 143–144
bugs and pests, 122                           contact allergies, 152–153
Burmese, 179                                  convulsions, 195–197
                                              copulation, 104–105
calcitriol, 213                               core vaccines, 85–87
calcium oxalate stones, 206                   corneal sequestrum, 192
Calici virus, 84                              corneal ulcers, 191–192
cancer, 93, 117–118                           Cornish Rex, 27, 166
cardiac ultrasonography, 167                  coronavirus, 218
cardiomyopathy, 168–169                       corona virus titer test, 89
cardiovascular system, 161–171                corticosteroids, 185
carnitine, 41                                 coughing, 132
carnivore, 39                                 creatine phosphokinase (CPK), 228
carprofen, 174                                creatinine, 116, 210, 227
carsickness, 56                               cryosurgery, 159
cauda equina syndrome, 199–200                Cryptococcus neoformans, 130
caudal vertebrae, 179                         cryptorchid, 14, 99
cautery, 163
cerebellar hypoplasia, 198                    Cushing’s disease, 189
cerebral spinal fluid tap, 232                cutaneous lymphosarcoma, 159
cerebrospinal fluid (CSF) analysis, 119–120   cysteine, 41
chemotherapy, 143, 189                        cystitis, 202
Cheyletiella, 157                             cystocentesis, 225
                                                                              Index 259

cystotomy, 208                               feeding tube, 145–146
cytology, 160, 231                           feline acne, 153–154
                                             feline calici virus (FCV), 86
deafness, 121, 194–195                       feline corona virus (FCV), 218–219, 228–229
declawing, 94–97                             feline diabetes, 185–187
degenerative joint disease (DJD), 122, 173   feline enteric corona virus (FECV), 89, 219
dental disease, 121, 136                     feline heartworm disease, 170–171
dental examinations and care, 76             feline hepatic lipidosis, 41
dermatological conditions, 34, 149–160       feline herpes virus (FHV-1), 86
dermatophytosis, 90                          feline herpesvirus, 86, 192–193
Devon Rex, 27, 166                           feline hyperesthesia syndrome, 200
diabetes, 40, 44, 118, 185–187               feline immunodeficiency virus (FIV), 21,
diagnostic tests, 223–233                       73–74, 84, 90–91, 97, 130, 136, 217–218,
diaphragmatic hernias, 102                      228–229
diarrhea, 48, 140–142                        feline infectious anemia (FIA), 165
diet, 43–44, 187, 206, 208–209               feline infectious enteritis, 85
dietary supplements, 70                      Feline Infectious Peritonitis (FIP), 84, 88–89,
digital flexor tenectomy, 96–97                 218–222
dilated cardiomyopathy (DCM), 41, 168–169    feline leukemia, 13, 21, 84, 97
Dirofilaria immitis, 170                     feline leukemia virus (FeLV), 73–74, 88, 130,
diseases, 45, 82, 130, 195                      136, 215–216, 228–229
diuresis, 212                                feline panleukopenia (FPV), 85
DTM (dermatophtye test medium) culture,      feline parvovirus, 223
  155                                        feline practice, 68–69
dystocia, 109                                feline rhinotracheitis, 129
                                             Feline rhinotracheitis, calici, panleukopenia
ears, 156–159, 194–195                          and chlamydia (FRCPC), 87
echocardiogram, 230                          Feline Rhinotracheitis, Calici and
electrocardiogram (EKG), 167, 231–232           Panleukopenia (FRCP) vaccine, 85–86
electroencephalograph, 194                   feline TLI (trypsin-like immunoreactivity),
electromyelogram, 198                           147
emergency providers, 69–70                   Feline Urologic Syndrome (FUS), 202
emergency veterinary clinics, 53–54          Fellow Membership of the AAFP, 68
endocrine system, 181–189                    female cat, 14, 21, 101–105, 187–188
endoscopy, 142, 230                          femoral head osteotomy, 180
enzyme-linked immunosorbant assay (ELISA)    feral cat, 103, 106
  test, 229                                  fibrosarcoma, 93
eosinophil, 132, 226                         FIP titer, 220
eosinophilic granulomas, 150                 fleas, 30, 34, 78–80, 109, 122, 149–150,
epilepsy, 195                                   152–153, 165
erythropoietin, 213                          flies, 122
esophagostomy tubes, 146                     flu, 138–139
estrus cycle, 14, 103–104                    food, 22–23, 38–45, 48, 58, 151–152
euthanasia, 123–124                          Food and Drug Administration (FDA),
Exotic Shorthair, 166                           40–41
external parasites, 80                       foreign bodies, 127, 139–140
eyes, 55, 191–194                            fractures, 176–177
                                             fungal infections, 130
fats, 228                                    fur, 32
fatty liver, 145–146
fecal analysis, 224–225                      gamma-glutamyl transferase (GGT), 227
feeding, 22, 40, 110                         gastritis, 143
260 Index

gastrointestinal system, 135–148               inflammatory conditions, 131
giardia, 77–78, 84, 91                         inguinal hernia, 102
gingivitis, 74, 136–137                        inhaled allergies, 151
glomerulonephritis, 210–211                    interstitial cystitis, 203
glucocorticoids, 189                           intervertebral disk disease, 199
glycosaminoglycans (GAGs), 175                 intestinal adenocarcinoma, 143
groomers, 35–37                                intestinal lymphosarcoma (LSA), 118, 143
grooming, 27–37, 64                            intestinal parasites, 77–79
gum disease, 136–137, 218                      itchy cats, 149–150, 156

hairball remedies, 31, 55, 137, 144            Japanese Bobtails, 166, 179
hairballs, 31, 55, 137–138                     jaundice, 145
head tilt, 195                                 joints, 174
heart, 161–162, 166–171                        Journal of American Nutraceutical Association, 175
heart disease, 119, 170, 182–184
heartworms, 170–171                            keratectomy, 192
heat, 106                                      kidney disease, 170, 210–213
helicobacter, 143                              kidneys, 44, 115–116, 201, 209–212, 227
Helicobacter felis, 143                        kitten, 2, 9–15, 21, 28, 30, 34, 42–44, 78, 81,
Helicobacter pylori, 143                         83–88, 91, 95, 99–102, 108–111, 127, 165,
Hemobartonella felis, 165                        178–180, 192, 198, 216, 219, 224
hepatic lipidosis, 41, 47, 145
hepatic scintigraphy, 147                      labor, 108–109
hernias, 101–102                               lesion, 150
high blood pressure, 116, 169–170, 183         lice, 80
Himalayans, 179, 192, 211                      licensed animal health technician, 66
hip dysplasia, 173, 180                        life expectancy, 112–113
histopathology, 160                            life-threatening problems, 53–54
hookworms, 77, 79                              life-threatening urinary blockages, 56
housesoiling, 24–26                            litter box, 4–7, 18, 22–23, 25, 121–122, 140,
hydrocephalus, 197                                201
hyperadrenocorticism, 189                      liver, 145–147
hyperesthesia syndrome, 200                    liver disease, 118–119, 145–147, 227
hyperglycemia, 186                             liver shunts, 147
hypertension, 116, 169–170                     longevity, 112–113
hyperthyroidism, 115, 119, 170, 181–184, 228   longhaired cats, 30–32, 211
hypertrophic cardiomyopathy (HCM), 169         Lower Urinary Tract Disease (LUTD),
hypoadrenocorticism, 189                          202–204, 208
hypoglycemia, 186                              lung cancer, 127
hyposensitization, 133                         lung disease, 120
hypothyroidism, 115                            lymphocytic-plasmacytic stomatitis, 137

idiopathic epilepsy, 195                       magnetic resonance imaging (MRI), 119,
illness, 24, 44, 46–61                          174, 198, 232–233
immunofluorescent antibody (IFA), 215, 229     male cat, 14, 21, 56, 97, 102–105, 204–206
inappropriate elimination, 24–26               malignant breast cancer, 100
indoor cat, 7–8, 17, 80                        malignant melanoma, 159
induced ovulators, 104–105                     mange, 80, 156–158
infections, 74, 160                            Manx, 179, 197
infectious diseases, 84                        mast cell tumors, 159
inflammatory bowel disease (IBD), 118          mats, 32–33, 36–37
                                                                             Index 261

medication, 54–61, 174–175, 185–187, 197,   parathyroid glands, 184
 200, 203, 213                              pectus excavatum, 180
medium-haired cats, 32                      pelvic fractures, 176
megacolon, 144, 248                         perineal urethrotomy surgery, 206
Megesterol acetate, 107–108, 185            peritonitis, 187
mental health, 17–18                        Persians, 36, 166, 179, 192–193, 211
metestrus, 14, 104                          personality, 1–2, 15
Microsporum canis, 90, 154                  pinkeye, 192
military dermatitis, 150, 152               pinworms, 79
mites, 80, 156                              Pixie Bobs, 179
monorchid, 14, 99                           plaque, 76
motion sickness, 56                         pleural effusion, 120
mouth, 135–137                              pneumocystogram, 207, 230
Mucopurin, 154                              pneumonia, 89, 133–134
mucus plug, 108                             polycystic kidney disease, 211
multiple cats, 21–23                        polydactyl cat, 29, 179
murmur, 166–167                             polyestrus, 100
muscles, 172                                polymerase chain reaction (PCR) tests, 229
musculoskeletal system, 172–178–180         pregnancy, 105–109
Mycoplasma haemofelis, 165                  privacy, 2–4
                                            proestrus, 14–15, 103–104
nails, 28–29, 96, 164                       psychogenic alopecia, 18, 153
nasopharyngeal polyps, 131                  puberty, 13–15, 103
neoplasia, 117, 131                         purebred cats, 211, 221
Nepata cataria, 197                         pyelonephritis, 210
nepetalactone, 197                          Pyoderma, 160
nephrotic syndrome, 210–211                 pyometra, 101, 187–188
nerve pain, 174
nervous system, 190                         queen, 106, 108–110
neurological disease, 24, 119–120           quick, 28
neurologic problems, 197–198
neutering, 13–14, 97–99                     rabies, 84, 86–87, 222–223
non-core vaccines, 87–91                    red blood cells, 162, 164–165, 226
Notoedres cati, 156, 157                    rehydrating cats, 48
nursing, 108                                renal amyloidosis, 211
nutritional requirements, 43–44             renal failure, 210–211
nutritional supplements, 174                respiratory system, 125–134
                                            restrictive cardiomyopathy, 169
obesity, 15, 17, 33, 40, 43–44, 174, 185    rhinoscopy, 127
osmolatity, 227                             Rhinotracheitis virus (feline herpes), 84
osteoarthritis, 173                         ringworm, 84, 90, 154–156
Otodectes cynotis, 156                      roundworms, 77, 79
outdoor cat, 7–8
ovariohysterectomy, 100                     saddle thrombus, 169
oxygenation, 162                            Sarcoptes scabei, 157
                                            scabies, 157
packed cell volume (PCV) test, 164          scarring of nasolacrimal drainage duct,
pancreatitis, 147–148                         192–193
Panel Report on Feline Senior Care, 113     scent glands, 148
panleukopenia, 13, 84, 223                  scintigraphy, 233
parasites, 77–80, 134, 140                  Scottish Fold, 166
262 Index

scratching, 17, 23, 94–95                  thyroid adenmoa, 181
sebaceous cysts, 159                       thyroid carcinomas, 183
seizures, 195–197                          thyroid tests, 228
senior cat, 43–44, 112–124, 199–200,       tissue biopsies, 231
   211–212                                 tissues, 172
senses, 190                                toes, extra, 29
serum glutamic-pyruvic transaminase        tomcat, 97, 106
   (SGPT), 227                             Toxoplasma gondii, 134
sexual maturity, 13–14                     traumatic experiences, 198–199
shedding, 27                               tricho, 31
shorthaired cats, 30, 33                   Trichobezoar, 31
Siamese, 197                               T3 suppression test, 182
sinus infections, 131
skeletal problems, 178–179                 ultrasound, 147, 167, 230
skeleton, 172                              umbilical hernia, 101–102
skin, dermatological conditions, 149–160   upper respiratory disease, 86–87
skin cancer, 159–160                       upper respiratory infections, 89, 128–130
slipped disks, 199                         upper respiratory tract, 125
sneezing, 86, 126–127                      upset stomach, 55
socialization, 11                          urate stones, 206
soft-tissue injuries, 177–178              ureters, 201
Somalis, 166, 211                          urethra, 201–202
sonogram, 167                              urethral obstructions, 144, 204–206
spaying, 13–15, 99–101, 187–189            urinalysis, 225
Sphynx, 27, 166                            urinary tract, 40, 201–213
spina bifida, 197                          urine, 44, 207–210
spinal cord, 190                           urohydropropulsion, 208
spinal disease, 198–200                    uroliths, 206
sprains, 177–178                           uterine infections, 187–188
spraying, 18, 21
squamous cell carcinoma (SCC), 159–160     vaccination, 12–13, 81–93, 218, 220–222
sterilizing, 97–99                         vaccine clinic, 67
stones, 206–208                            veterinarians, 21, 48, 53, 62–70, 76
strains, 177–178                           veterinary clinic, 63–67, 73
stress, 4, 18, 22–23, 128, 186             viral infections, 128–129
strokes, 120                               viral tests, 73–74, 228–229
surgery, 94–102, 180, 206, 208, 231        viruses, 214–223
surgical biopsies, 142                     vitamin deficiencies, 42
sweating, 72                               vomiting, 48, 55, 137–139, 142–143, 170, 223

tablets and capsules, 58–60                water, 44–45, 48, 59, 121
tactile vibrissae, 20                      water on the brain, 197
tails, 19–20, 23, 179, 199                 whipworms, 77
talking, 26                                whiskers, 19–20
tapeworms, 77–78                           white blood cells, 162, 226
tearing, 192–193                           Wood’s lamp test, 155
technicium scan, 182
teeth, 74–77                               X rays, 229–230

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